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This confidential online form takes approximately 5 minutes to complete and allows you to save valuable time in your first session! Items marked with an " * " are required.
*First Name: Last Name:
*Gender: Male Female
*Email: Phone: Skype: Country: *ZipCode:
*Issues (Major Complaints, Symptoms) In order of priority if more than one: *1. 2. 3. 4. 5. *When did the above issues begin?
*How often does your #1 issue bother you? Please Choose Constant Daily Weekly Monthly Every once in a while Only when I ......
*Can you relate any of the issues you listed above to any events in your life? What events?
*What makes your #1 issue worse?
*What makes your #1 issue better?
*Please describe your current issues that bring you to a session in as much detail as you believe will be helpful:
Please describe three specific events that you feel may have contributed to your problem: *1. 2. 3.
*What is your experience with Meridian Tapping Techniques (MTT)? No experience is required.
*How did you hear about Joe Oliver? Please Choose Friend Business Associate Work Flyer Google Other Search Engine Other web site Other If Other, please explain:
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