Application Form If you’re wanting to work with me, please fill out the application form below and you will be contacted about scheduling your consultation Name * First Name Last Name Phone (###) ### #### Email * What problem(s) are you wanting to be resolved? * How long have you been struggling with this? * How does it affect you? * What will happen if you don’t resolve this problem? * Have you received help before on this particular issue? If so, did it help? Thank you! You will be contacted to Schedule your session!
