It is all about life

Intake Form


​Would you kindly complete this form and submit it at least ​one day before your appointment.
​Don't hesitate to contact me if you have any questions

    Client information


    General Practitioner


    FOCUS PROBLEM:
    Can you describe the situation/problem that you would like to bring in therapy?






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Lara Briozzo 
It is all about life - Coaching, Counseling & Psychotherapy
kvk 63578611- AGB 90106164 - AGB praktijk 90065390 –
VIT lidmaatschapnummer 608.18.A – RBCZ licentienummer 190262R​
www.ItIsAllAboutLife.eu; Tel. +31 (0)6 13016291; info@itisallaboutlife.eu;