Pain & Migraine Registration

You will be contacted for an appointment when we receive your completed form.

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  • Once you make this payment complete the second half of the form that asks details about your lifestyle problem. All information is confidential and only seen by Dr. Smith.
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    Supported Credit Cards: American Express, Discover, MasterCard, Visa
      

  • Please Return to the Registration Page and See Testimonials Before Your Appointment.

WEIGHT LOSS

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PAIN & MIGRAINE

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STOP SMOKING

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ANXIETY & DEPRESSION

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ALCOHOL & DRUGS

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GAMBLING

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