First Name
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Last Name
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Valid Email
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Phone Number
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What is your top challenge that you would like us to help you overcome?
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Why is this goal important to you, and what do you think is stopping you from accomplishing it?
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How did you hear about us?
I understand I am requesting a free "Discovery Consult" with the provider. I will first be talked to by a staff member and then will be scheduled. In order to schedule, it is required to have a card on file. If I do not show or reschedule with less than a 24 hour business notice, I am giving Peak Brain and Body permission to charge my card a $75 fee.
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Yes, I agree to this policy and would like to move forward.
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