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Parent Name (required)

Parent Email Address (required)

Your Phone Number (required)

My child is between the ages of: (required)
0-34-67-910-12Over 12

The reasons I am seeking a consultation are:

Please select the following consultation length: (required)
15-minute consultation for $2530-minute consultation for $4560-minute consultation for $80

I understand a consultation is not diagnostic in nature. I understand that I will be emailed a fee prior to the consultation and that if I do not pay the fee, the consultation will be canceled.

I Agree