Booking Form

After receiving your completed booking form and payment, you'll be emailed directly to schedule your consultation date and time.

All information submitted will forever and always remain completely confidential.  

I look forward to working with you!

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CLIENT DATA

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BIRTH DATA

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Please understand that your consultation is for informational purposes only; does not constitute and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, mental health professional, or other qualified health provider with any questions you may have regarding such issues of concern. By checking this box, you agree to take full responsibility for any and all decisions and outcomes that may derive from information shared in this session.

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