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).

1st

2nd

3rd

4th



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



Contact Rohan

Send me a message and I'll get back to ya with the quickness!