Thank you so much for your interest in working together! Please fill out this form to start the process.

Based on what you share with me here, I will be able to give you an estimate of when we can have our first meeting, and then the appropriate booking link.

First Name *

Last Name *

Email *

Mobile Phone *

Time Zone *

Request Details:

What Are You Interested In? *

Brain Rewiring/Nervous System Regulation Help

Help with Healing from Mold

Becoming a Brain Rewiring Practitioner/Coach

Other

If other please specify:

Preferred Start Date:

Contact Method Preferred:

Text

Clients Needs And Goals

What are your top three goals you hope to achieve with this help?? *

How did you hear about Dr. Cureton?

I Consent to Receive SMS Notifications & Reminders from Dr. Cureton. Message & data rates may apply. You can reply STOP to unsubscribe at any time.