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This form gives me relevant information for scheduling and treatment.
If my schedule is full, I can either put you on a wait list or direct you to a practitioner in your area. In all cases I will contact you to discuss the possibilities.

I can assure you that the information in this form will be treated with the utmost confidentiality.
After filling in the form, please click on the “Send” button at the end.
Thanks for your interest.

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