Client Program Confidential Questionnaire and Disclosure

Patient Intake & Consent 2021

Please complete the form in its entirety before your appointment.

Medications & Allergies

Past Medical History

WaveTech Raleigh
2605 Blue Ridge Rd. #320
Raleigh, NC 27607

(919) 616-7244

raleigh@wavetechtherapy.com

Military Discount