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Inquiry Form

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Please fill out the contact form according to your comfort level. Those questions starred are necessary.

Calendar

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Including other practitioners you have seen.” field_type=”text” required_mark=”off” fullwidth_field=”on” _builder_version=”3.2″ /][et_pb_contact_field field_id=”Have_you_looked_over_my_website_and_offerings” field_title=”Have you looked over my website and offerings?” field_type=”radio” radio_options=”%91{%22value%22:%22YES%22,%22checked%22:0},{%22value%22:%22NO%22,%22checked%22:0}%93″ required_mark=”off” _builder_version=”3.2″ /][et_pb_contact_field field_id=”Are_there_any_issues_or_health_concerns_you_would_like_to_share_with_me” field_title=”Are there any issues or health concerns you would like to share with me?” field_type=”text” required_mark=”off” _builder_version=”3.2″ /][et_pb_contact_field field_id=”What_type_of_session_are_you_interested_in” field_title=”What type of session(s) are you interested in?” field_type=”text” required_mark=”off” _builder_version=”3.2″ /][et_pb_contact_field field_id=”Do_you_have_a_date_and_time_or_a_few_dates_and_times_that_you_are_interested_in_possibly_scheduling” field_title=”Do you have a date and time or a few dates and times, that you are interested in possibly scheduling. (The more options that work for you the better for me to create ease in scheduling)” field_type=”text” required_mark=”off” _builder_version=”3.2″ /][et_pb_contact_field field_id=”Are_you_aware_of_my_24_hour_cancellation_policy” field_title=”Are you aware of my 24 hour cancellation policy?” field_type=”radio” radio_options=”%91{%22value%22:%22YES%22,%22checked%22:0},{%22value%22:%22NO%22,%22checked%22:0}%93″ required_mark=”off” _builder_version=”3.2″ /][et_pb_contact_field field_id=”Are_you_aware_of_my_deposit_policy” field_title=”Are you aware of my deposit policy?” field_type=”radio” radio_options=”%91{%22value%22:%22YES%22,%22checked%22:0},{%22value%22:%22NO%22,%22checked%22:0}%93″ required_mark=”off” _builder_version=”3.2″ /][et_pb_contact_field field_id=”Are_you_aware_of_my_painless_screening_policy” field_title=”Are you aware of my painless screening policy?” field_type=”radio” radio_options=”%91{%22value%22:%22YES%22,%22checked%22:0},{%22value%22:%22NO%22,%22checked%22:0}%93″ required_mark=”off” _builder_version=”3.2″ /][et_pb_contact_field field_id=”If_you_were_to_choose_the_best_3_words_to_describe_what_you_are_wanting_to_create_for_your_life_thru_a_session_with_me_what_would_they_be” field_title=”If you were to choose the best 3 words to describe what you are wanting to create for your life thru a session with me what would they be?” required_mark=”off” fullwidth_field=”on” _builder_version=”3.2″ /][et_pb_contact_field field_id=”Would_you_like_to_receive_my_newsletter” field_title=”Would you like to receive my newsletter?” field_type=”radio” radio_options=”%91{%22value%22:%22YES%22,%22checked%22:0},{%22value%22:%22NO%22,%22checked%22:0}%93″ required_mark=”off” _builder_version=”3.2″ /][et_pb_contact_field field_id=”Anything_else_you_would_like_to_add_here” field_title=”Anything else you would like to add here?” field_type=”text” required_mark=”off” _builder_version=”3.2″ /][/et_pb_contact_form][/et_pb_column][/et_pb_row][/et_pb_section]