NEW CLIENT FORMS

New client forms can be downloaded here!  Please complete them and E-mail to info@jackieslomin.com prior to your appointment or bring printed copies with you to your appointment.

If you have made a new client account on Healthie, all forms are available to fill out online instead for your convenience.

Client Agreement Form

HIPAA Privacy Practice

Information Release Authorization

New Client Intake Form

Breeze through your weight certifications with my FREE goal weight calculator for wrestlers

Long Island Office

200 Old Sunrise Hwy

Massapequa, NY 11758

516-308-2485

info@jackieslomin.com

Hours

Mon  8:00am - 8:00pm

Wed 8:00am - 8:00pm

Fri    8:00am - 8:00pm

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