Please complete this application for a free consultation. If selected, you will be notified within 3 business days.
Name
Email
Phone
Age
Are you able to be available [list your availability] for appointments?
Please Briefly describe your current symptoms
What have you already tried to resolve these problems?
How are these issues holding you back from your life, career and aspirations?
Why is now the right time for you to address these issues?
Do you think friends and family will be supportive of you making changes to improve your health?
Finally, gauge their ability to pay for your services and simultaneously plant the seed that this is an investment
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