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Appointment Request
Thank you for taking this step to attune to your wholeness and align with greater well-being.
I am excited and honored to be part of your journey.
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Email
*
Your email
Full Name (first & last)
Your answer
Phone Number (best)
Your answer
What is your preferred form of communication?
Phone
Text
Email
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Are you a current client?
Yes, please use my online scheduler at:
drjessica.as.me
No, I would like to have individual sessions. Please schedule me for a 90 minute initial visit.
No, I would like to begin Network Care (group setting). Schedule a private 60 minute initial visit.
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What type of session would you like?
In person
Phone
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Please indicate preferred session days?
Monday
Tuesday
Wednesday
Thursday
Friday
Other:
What is your ideal session time?
Your answer
How did you hear about this practice?
Your answer
Is there anything else you would like to share?
Your answer
Thank you for your inquiry.
Please note that inquiries are most commonly replied to on Tuesdays, Wednesdays and Thursdays.
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