Private Client Application

Take the First Step in Your Wellness Journey TODAY!

First Name

Last Name

What is your primary health concern you woud like to address?

Do you have any other health concerns you would like addressed?

What are your health goals?

How quickly do you want to achieve your health goals?

If we were having a discussion three years from today, and you were looking back over those three years, what has to have happened in your life, both personally and professionally, for you to be happy with your progress? (Credit – Dan Sullivan)

Are you familiar with Homeopathy? Required

Yes

Are you familiar with Pranic Healing? Required

Yes

What have you already tried to address your health concerns?

What are you willing to invest financially to address your health concerns and achieve your goals? Required

Is there anything else you would like to share?

Thanks for submitting!

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