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Tell Us About Yourself
First & Last Name
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Email Address
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City & Country
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Phone Number
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Please describe in detail the problem you are facing that you want to address and since when?
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What have you tried so far to address this problem?
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Are you currently working with any healthcare practitioner? Have you been prescribed any pharmaceutical drugs? If yes, please provide details.
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Is there any specific area you'd like to focus on?
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What is the level of support you need?
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What is the level of support you need?
Weekly
Biweekly
Monthly
Other
Please specify the amount you're comfortable investing in yourself
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Would you prefer the payment to be based on:
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Would you prefer the payment to be based on:
Individual calls
Monthly payments
Package payment
Is there anything else you'd like to share?
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