"My Body Is Not Me Program" Consultation Form

 

"My Body Is Not Me" Program Consultation Form

Please fill out this consultation form to the best of your abilities.  In the "questions" section of this consultation form, you can ask for any emotional or spiritual insights about your life/health.  Please click the "Submit" button and then the "Upload a Recent Picture" button.  

Name *
Name
Birthday *
Birthday
I understand and have read Rae of Hope LLC's disclaimer. Copyright 2017-2018 Rae of Hope LLC Disclaimer: Rachel Reimer from Rae of Hope LLC is not a medical doctor or licensed health care practitioner, and does not claim to be one. Rachel from Rae of Hope LLC does NOT diagnose, treat, prescribe, mitigate, alleviate or care for any disease of any kind. Her spiritual advice sessions are not a replacement or substitute for appropriate medical care. A spiritual advice session is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Always consult a physician or trained health care professional for diagnosis and treatment of any medical problem, issue, disease, or condition.