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Interested in working together? Fill out some info and we will be in touch shortly! We can't wait to hear from you!

Name

First Name

Last Name

Email

What are your main health concerns?

What have you tried so far?

What medications and supplements are you taking?

Have you ever been on a Benzodiazepine or SSRI?

Yes

No

Healing is an expense. Tests and coaching are not cheap. Are you prepared for the expenses that come with this?

Yes, I have the funds now and am ready!

No I do not have the funds now, but have credit or will ask family and friends

No

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