Step 1: Join the PMA Member Share Network
I look forward to making it possible for you and your family to have access to safe, effective options for your health. To enjoy the benefits of the Member Share Network you must read and agree with the Member Share Agreement. You are electronically accepting the terms of this agreement by proceeding with member registration and a copy will be emailed to you by email after registration.
- Practitioner Name: Tracey Middleton
- Practitioner email address: firstname.lastname@example.org
Step 2: Tracey’s Client Intake Form Online
You can also download a PDF version of Tracey’s Client Intake Form here: clientintakeform.pdf
Upon submitting this form, please email Tracey directly to alert her to your form submission: email@example.com
*Informed Consent adapted from the book Creating Healing Relationships by Dorothea Hover-Kramer.