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.
Name *
Email Address *
Telephone Number *
1. Please provide just a headline, of what you’re looking to address. *
2. Have you tried therapy or counseling before? *
3. Are you currently seeing a therapist or counselor? *
4. What are you doing, feeling, or thinking that you want to change? *
5. What is your desired outcome from your Transformation visit? *
6. How did you hear about Michael Cortina? *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy