Brain Consultation Application Form
By submitting this form, you agree to pay the discounted discovery rate ($50 USD) to cavin@feedabrain.com 24 hours before your scheduled call. After submitting this application form, you will be directed to a confirmation page where there is a link to schedule your discovery call.
Email address *
Full Name
Do you have a Skype handle? If yes, add me on Skype (CavinB9), and leave your Skype handle here. If not, write "no" *
What is your phone number? *
Your age *
Your Sex
Your location
Loved one's age (if applicable)
Loved one's location (if applicable)
Loved one's sex (if applicable)
Date of Event (if applicable)
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Please explain your situation and why you are reaching out. (please be as detailed as possible) *
What are your hopes as of now? How would you like to see the future for you and your loved ones? Be specific (if you're not sure, I want you to think about this question and to be able to describe your vision on our call). *
Have you read Cavin's book, How to Feed a Brain? (yes, no, currently reading, other (please explain)) *
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Please list all medications and supplements being used. Try to be specific with brand names and dosages if possible, but don't let this hold you up (we will go over this on the phone and you can edit this form after submitting). *
Please describe current diet of you and/or your loved one, whichever is applicable (we will go over this on the phone and you can edit this form after submitting). *
Are you prepared to make a significant mental, emotional, and financial investment to bring about the best possible scenario for you and/or your loved one(s)? *
Please upload any photos, videos, or medical records that you'd like me to see (or you can send them to consult@feedabrain.com).
Is there anything else you would like me to know before our conversation?
Do you agree to pay the discovery rate ($50 USD) at least 24 hours before your scheduled call. You can pay via PayPal here: https://www.paypal.me/feedabrain/50 *
Thank you for your responses. After submitting this form, a scheduling link will be provided. Be sure to click on that link and to schedule an appointment. Cavin will then contact you at the scheduled time. Please come with paper and something to write with.
After submitting this application form, you will be directed to a confirmation page where there is a link to schedule your discovery call.

Discovery calls with Cavin are discounted at a rate of $50. By submitting this form, you agree to pay the discovery rate ($50 USD) before your scheduled call. You can pay via PayPal here: https://www.paypal.me/feedabrain/50. By submitting this form, you also agree to the following: Any information or advice provided is not intended to replace the services of a physician. Reliance is solely at one's own risk. Cavin Balaster has no formal medical training and his consultations are for informational and emotional support purposes only. Consultations are not a substitute for professional medical advice. Any action on the clients part in response to the information provided is at the clients' discretion.

A copy of your responses will be emailed to the address you provided.
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