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Acute Consultation Request Form
Thank you for your interest in working with The Healing Guild! We look forward to helping you heal. Please fill out the form below, and one of our practitioners will be in touch to schedule your session.
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Name:
*
Your answer
Email Address:
*
Your answer
Phone Number (Optional):
Your answer
Description of Complaint:
*
Your answer
Duration of Complaint:
*
Your answer
Do you have a preferred practitioner?
*
Alison
April
Priscilla
No preference
What is your homeopathic experience level?
No experience- Just starting out
Some experience- I've used Homeopathy a few times
Fair amount of experience- I use Homeopathy regularly
Well-experienced- I am a seasoned Homeopathic user or practitioner
Clear selection
Is there anything else you would like us to know?
Your answer
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