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Enter your Name*
User e-mail*
What Brought you Here?*
How can I assist you, what do you need?*
What would your life feel and look like when you get better? *
In what ways can I assist you in this? What do you need me for? *
How do you see that happening? *
What are your beliefs about healing?*
Do you believe in god/ higher power? *
Do you want to be well? *
Please enter your Skype, Zoom, for Facetime ID
Best method to contact you
Enter your phone number, Skype ID, Zoom Username, or Facetime ID*
Choose your first appointment date*