Brain Optimizing Transformation Visit Application
Michael only works with people who are serious about overcoming trauma, PTSD, and life’s challenges. Complete the application below to work with Michael.
* Required
Name
*
Your answer
Email Address
*
Your answer
Telephone Number
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Your answer
1. Please provide just a headline, of what you’re looking to address.
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Your answer
2. Have you tried therapy or counseling before?
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Yes
No
Other:
3. Are you currently seeing a therapist or counselor?
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Yes
No
Other:
4. What are you doing, feeling, or thinking that you want to change?
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Your answer
5. What is your desired outcome from your Transformation visit?
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Your answer
6. How did you hear about Michael Cortina?
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Your answer
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