FIRST NAME *

LAST NAME *

EMAIL ADDRESS *

WHERE ARE YOU BASED? *

Enter your country

Dr Gladys works with clients internationally

WHICH MEDICAL CONDITIONS? *

Tinnitus

Hyperacusis

Hearing loss

What have you already tried? (optional)

Tinnitus counselling

Mindfulness or meditation

Sound therapy or masking

Hearing aids

Medication or supplements

Nothing yet

Other

Specialist appointments

What have you stopped doing because of tinnitus, and what would you most like to say yes to again? *

A few sentences is plenty. Dinners, travel, family, work, sleep.

Is there anything else about your health I should know? (optional)

Rebuild™ is private 1:1 coaching. The fee is £2,950 or you can spread it over 3 or 6 months. Are you able to invest in this? *

Yes, I can invest, including a payment plan

Not at this time

Pre-assessment calls are for applicants who are able to invest in Rebuild™.

Rebuild™ is private 1:1 coaching. The fee is $4,000 USD or you can spread it over 3 or 6 months. Are you able to invest in this? *

Yes, I can invest, including a payment plan

Not at this time

Pre-assessment calls are for applicants who are able to invest in Rebuild™.

By checking this box, I consent to Dr Gladys Sanda storing and processing the information that I have shared for the purpose of reviewing my suitability and contacting me about next steps. I also agree to receive occasional emails relevant to tinnitus support and know that I can unsubscribe at any time. My details will never be shared with anyone else.

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