RESET Signature Application Form

Please answer the below questions. Once completed Sarah will contact you to arrange a free call to make sure this is the right program for you.

Would You Consider Your Childhood Happy

Yes

No

Not Sure

If No or Not Sure Please Give A Brief Summary Of Your Childhood Expereinces

How Does Your Mental Health Affect You In Your Life?

If You Could Wake Up Tomorrow Happy, What's One Significant Thing That Would Be Different To Enable You To Feel Happy?

Are you ready to invest in your mental health?

Yes

No

Not Sure

First Name *

Last Name *

Phone *

Email *

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