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Functional Mental Health Practitioner Certificate Application
Please fill out this form in its entirety.  Once complete, I will send you the scheduling link to book your complimentary FMHP call to the email you provide below. :-) 
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Email *
Phone Number *
Full Name *
What is a good email for us to send you more information and communicate with you? *
What are your health professional credentials? *
How long have you been a health professional? *
What types of clients/patients do you work with? *
What do your clients/patients typically struggle with? *
Are you currently using lab testing in your practice? If so, what type of testing do you use? *
What do you hope to get out of this program? *
These questions are simply to get a feel for your Functional Education Level to determine if this program is a good fit for you. Don't stress. Have fun with it!  Please elaborate on anything you think is relevant about your experience that you think would make you a great fit for this certificate program. *
Were you referred to this program? If so, by who?
This Certificate Program is an advanced self-paced program.  To obtain a certificate of completion, there is a final exam. The current cost for the level 1 Program is $8497.  We do offer payment plans (3, 6, 12, 24 month).  We have a strict no refund policy. 
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