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Help Request

Whatever your concerns might be, whether big or small, My Healing Way therapists want to hear from you.  If you would like to improve your health, better your performance, or that of your loved ones, human or otherwise, don’t hesitate to fill out our Help Request Form.

Important!

Before any recommendations can be made, it is important to understand your situation as fully as possible so be specific, ask questions if you need to, and we’ll do our best to address your request within 48 hours. Be sure to read the FAQ section if you are unsure about anything.

Remember, by coming this far, you’ve shown determination and positivity, and we believe that’s a very important first step on the path to your well being.  We look forward to hearing from you!


Please provide us with some basic information so that we can contact you about your request. Know that your privacy is very important to us and any information you provide is strictly confidential (see our Privacy Statement).

Name

FirstLast

E-mail

Phone Number

I am seeking help on behalf of

If the patient in question is not you, please provide the patient's name

FirstLast

and the patient's relationship to you

Gender

Date of Birth

Day / Month / Year

Place of birth

CityState/ProvinceCountry

Current residence

CityState/ProvinceCountry

Please, describe the problem, be as detailed as you can. Also mention if you have sought medical help, been diagnosed, or undertaken any procedures or regimens.

If you feel your message would be better communicated with a picture (photo, x-ray, CT scan, MRI, etc) you may include it here.


By checking this box, I certify that I have read and agree to the terms laid out in the Disclaimer.