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8-Week Transformational Program Application:
Fill out this form and Dr. LeTa will give you a call.
Full Name
*
First Name
Last Name
Phone Number
*
E-mail
*
example@example.com
How did you hear about this program?
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Google or another internet search
Word of Mouth
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Are you ready to make some changes?
Yes
I'm not sure
It depends on how much time
It depends on how much money
Please tell us a little bit about you and why you'd like to join Dr. LeTa's 8-Week Program?
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