# Clinic Intake/ Waiver Form
## 2022
### DISCLAIMER
- THIS IS NOT LEGAL ADVICE. ....INCLUDE DISCLAIMER LANGUAGE HERE. *SEE*, SAMPLES FROM COMPANIES THAT FILE TRADEMARK APPLICATIONS THAT ARE NOT LAWYERS BUT PROVIDING LAWYER LIKE SERVICES [*SEE*, ROCKETLAWYER for fine print AND LEGAL ZOOM for heads up]

- INCLUDE: LAW STUDENTS ARE NOT LAWYERS/ DO NOT RELY.

- Parties acknowledge and have been advised to obtain independent legal counsel. By signing this herein Agreeement you understand that it is strongly advised to seek a license attorney in your jurisdiction.

### BASIC CLIENT INFO
- Client Info - Name; Contact info (Phone No.:, Discord, Email, Twitter); Persons involved if KYCed

### PROJECT / FACTS
- GOALS / ISSUES

### OTHER
- CONFLICT OF INTEREST