Contact
Full Name
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Email
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Phone
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Day and preferred time
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Alternate Time
Preferred length of session
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Have you been heathy and free of symptoms for the past 2 weeks?
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*Please share a few words about your intention and what is your reason for seeking me out today? Please share a few short words.
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Are you a returning patron or a new seeker?
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Returning Patron
New Seeker
New Seeker:
Your City, State of Residence
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Where did you find me?
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What draws you to my practice? How can I support you?
Your board handle or p411/rs2k member details
Choose a screening option. I will NOT see you unless you provide the required information.
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Professional information
Provider references
Professional Information
Link to professional website or Linked-in profile
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Work Email
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To verify it's authenticity I will send you a short message to your work email. If company privacy is a concern, you may email me a photo of your ID.
Provider References:
Provider reference #1:
Please let your provider know that I will be contacting her.
Provider Name
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Contact
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Website or current online ad
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Provider reference #2:
Please let you provider know that I will be contacting her.
Provider Name
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Contact
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Website or current online ad
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Cancellation Policy: I require 1 day notice or a cancellation fee of 50% of your donation amount.
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I Agree
Phone
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