BlackTherapistsIreland
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Client Returned / Declined
Please Fill The Form Below.
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Therapist's Name
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Last
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Client's Name
*
First
Last
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Client Type
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Date
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Reason for Return/Decline
*
Any relevant Additional Information
*
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For any assistance please contact
ejiro@blacktherapistsireland.ie
THE INFORMATION ON THIS FORM IS HELD IN STRICT CONFIDENCE.
Home
Work With Us
Meet Our Therapists
Ejiro
Fidelia
Daisy
Charles
Mariam
Abiola
Cassandre
Sasha
Esther
Omobolaji
Nave
Alex
Emelda
Audrey
Greg
Natanielle
Blog
Contact