Apply to Work with Dr. Tasnuva
This is the Intake Form for the Waiting List to get inside Autism Transformation & Success programs
This is NOT a certification Program. You will be taught our proven system to help your child recover from their developmental difficulties.
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Email *
Have You Read The PROGRAM DETAILS page THOROUGHLY yet? If Not, You will be declined your call and spot if you haven't read the Full Page carefully. *
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Full Name of Guardian *
Country of residence. *
Where did you Find us or Heard about us? *
WhatsApp Number *
Full Name of Child plus Age *
Detailed Diagnosis of your child? *
What Have You Tried So Far? *
What are your Current Struggles with your child? *
Top 3 Goals you want to reach for your child? *
What are some of the things holding you back from reaching those goals? *
Why Do You Think We are a Good Fit to work together? *
Why Do You Think NOW is the best time for You to join our Elite Program? *
What is your level of education and understanding about Health science & brain development? *
Monthly Household Income *
How MOTIVATED & COMMITTED are you towards reaching your goals? *
I would rather wait and suffer
I am ready for transformation
Which one of the following options best describes you right now divine parent? *
If you  Do you have cash/credit or finance ready to go? *
Is there anything else you want to share with us today? SHARE YOUR COUPON CODE if you have.
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