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First Name

Last Name

Phone

Email

How many of these challenges effect you? Select all that apply.

Pain

Head Ache

Achy Joints

Stress - Physical / Mental or Job Related

Negative Thoughts

Anxiety

Sleep

Energy

Performance

Fatigue

Mental Focus

Memory

Circulation

Hormones

Immune System

Would you be intrested in a FREE personal Frequency session?

Yes

No

Thanks for your feedback!

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