Patch Recommendation Form
Please fill out to the best of your ability. The more information received, the better we are able to tailor your patch choices to your health goals.
Full Name
*
First Name
Last Name
Email
*
example@example.com
Contact Number
*
If neither Dr. Kayla nor Dr. Anthony are who sent you this form, please fill out the name of the person who did. Please include their e-mail if available.
First Name
Last Name
Email Address
example@example.com
Please Check Any of the Following You Are Experiencing (must make at least one selection)*
Sleeping Problems
Hormonal Issues
Chronic Fatigue
Anxiety
Memory Fog
Allergies
Clarity/Focus
Hyperactivity
Asthma
Indigestion
Heartburn
High Blood Pressure
Food Cravings
Accelerated Aging
Depression
Low Energy
Balance Issues
Blood Sugar Issues
Racing Mind
Cold Hands/Cold Feet
Varicose Veins
Migraines/Headaches
Vision Issues
Skin Conditions
TMJ
Constipation/Diarrhea
Heart Condition
PCOS
Insomnia
Neuropathy
Chronic Pain
Autoimmune Disorder
Musculoskeletal Pain
Back/Neck/Joint/Other Pain
Digestive Issues
Infertility
Cancer
Other
Please tell me in your own words what your main goal is for starting your healing journey. If you have multiple goals, please list them in order of priority. Ex. Number 1 would be top priority.
*
Are there any patches that you already know you absolutely want to get? Please list those below if so. If not, type "no".
NOTE-
After submitting the form, please give Drs. Anthony & Kayla Abeid 2-3 business days to get your recommendations back. You will receive your recommendations via e-mail. If someone other than the Drs. Abeid sent you this form, they will also reach out to that individual to make them aware of your recommendations so they can help you as efficiently as possible with setting up your order to begin your patching journey. We are so excited for you to begin to experience the amazing healing power of phototherapy like thousands of other individuals, including our family and practice community, have already experienced.
Disclaimer: The recommendations provided through this patch suggestion form are not intended to be interpreted as medical advice, diagnosis, treatment, or cure for any symptoms or health conditions. These suggestions are made based on the individual qualities of each patch that LifeWave provides to help enhance your overall well-being. By submitting this form for patching recommendations, you acknowledge that neither Dr. Kayla nor Dr. Anthony assume formal care or responsibility for your health. These recommendations are intended for informational purposes only and do not establish a doctor-patient relationship. Always consult with a qualified healthcare professional before making any decisions regarding your health.
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