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After downloading and reading the Reconnective Healing Intake Form, sign below and submit. You can then use PayPal to purchase  your session. 


Email Address*

I understand that by signing this online form, I acknowledge that I have read and understand the Reconnective Healing Intake form downloaded from the page and agree to it's terms & conditions. Type your name below*

Phone Number*


Go to to pay directly or click the button below. 

Thank you for contacting us. We will get back to you as soon as possible

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