Products Price Quantity Total

Products		Price	Quantity	Total
REQUIRED Onboarding Fee Includes a 1-1 screening call and medical/mental health intake evaluation form. This is a ONE TIME fee required and I reserve the right to rescreen you at any time during your community subscription membership.	$50.00	Update	$50.00
Subtotal			$50.00

REQUIRED Onboarding Fee

Includes a 1-1 screening call and medical/mental health intake evaluation form. This is a ONE TIME fee required and I reserve the right to rescreen you at any time during your community subscription membership.

$50.00

Update

$50.00

Subtotal $50.00

Billing Information

* First Name

* Last Name

Company Name

* Address - Line 1

Address - Line 2

* City

* State

* Zip Code

* Country

* Phone Number

* Email Address

Order Summary

Subtotal $50.00

Order total $50.00

Order Summary
Subtotal	$50.00
Order total	$50.00
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