Complimentary Consult – Rohan Jasani

Exploratory Consultation

Schedule your FREE 15min. Exploratory Phone Consultation today!

Regardless of whether you would like more information or are ready to work with me, all potential clients MUST have a Exploratory Consultation with me initially before moving forward. This allows for each of us to assess whether we’d be a good fit to work together. Furthermore, it’ll give you a feel for what to expect.

1. Contact Information

Name *

Email *

Preferred Phone Number *

Is it ok to leave a message at this number above?*

YesNo

2. Questions

Your answers will stay strictly confidential.

What health issues(s) would you like help with? *

What approaches or treatments have you tried and what results have you experienced? *

How did you hear about my services? *

I send out a monthly newsletter containing health tips. Would you like to be added to my list?

YesNoI'm already signed up!

I conduct the FREE 15min. Exploratory Phone Consults every Mon. & Weds at 6PM & 6:30PM CST. Please rank your preferred timeslots for the next week (1=most preferred, 4 = least preferred).

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3. Informed Consent

I understand the 15-minute Exploratory phone consultation is used to determine if I am a candidate for care and does not establish me as a client of Rohan Jasani. I also understand there is no practitioner-client relationship or obligation between myself and Rohan Jasani based on meeting for a exploratory consultation.

Do you understand and consent? *

Yes

4. Next Steps

I'll be in touch to confirm your exploratory consultation date & time. I look forward to possibly working with you.

Rohan Jasani