Life Reset Services - Your Energy Doctor

Life Reset Services - Your Energy Doctor
Name*

First NameLast Name
Email*
example@example.com
Cell Phone Number (US Only):
Used for texting before, during or after the email sessions. You will receive a text from Dr. T's personal cell: 206-356-2345
Phone Number (US Only):
Number to call for phone session. You will receive a call from 970-685-4017.
Specific personal details are needed to program the bio-scanner.
This information will not be used in any other way.
Headshot:*

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Height in Inches:*
Weight in Pounds:*
Birthdate:*

MonthDayYear
Date
What are your primary reasons for receiving this scan? What health or well-being concerns or wellness goals do you have?*
WELL-BEING STATEMENT:

I understand and take full responsibility for my well-being and I am willing to seek a qualified healthcare professional for any personal acute or specific medical health concerns I may have.

DISCLAIMER: The information presented during this session does not medically diagnose, treat, cure or prevent any disease or psychological disorder. This is not a substitute for medical advice. Reported results vary and hold no guarantee for your specific results. It is understood and expected that you take personal responsiblity for your own well-being. Seek a qualified healthcare professional for any personal acute or specific medical health concerns you may have.

PLEASE BE FULLY HYDRATED BEFORE THE SESSION TO MAXIMIZE YOUR RESULTS
I have read and agree to the WELL-BEING STATEMENT and DISCLAIMER. I give my full consent to have this session with Dr. Debbie Thompson, Neuro-Connections Coach, Holistic Chiropractor.*

YesNo
Expect the Miraculous!
Appointment completed on the day chosen [You do not have to be present]:
Should be Empty: