Discovery Form

    Please describe any current physical complaints. Be sure to include how long they have been an issue.

    On a scale of 1 to 10, with 10 being the highest, rank the level of severity of your physical complaints. (Choose One)

    If you were free from these physical complaints, what would it allow you to do?

    Please describe any current emotional complaints. Be sure to include how long they have been an issue.

    On a scale of 1 to 10, with 10 being the highest, rank the level of severity of your emotional complaints.

    If you were free from these emotional complaints, what would it allow you to do?

    How do you feel a Discovery Session will benefit you?

    Yes, I would love to apply for a FREE limited Discovery Session!

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