Complete all fields accurately and provide as much details on your medical history where indicated.
- By submitting this form, you are giving express consent to receive a Quantum Health Session.
- You also understand and agree that receiving a Quantum Health session from Gayathri does not replace current or ongoing medical protocols or your physician’s advice.
- Please email a recent photograph (not older than 3 months) if live internet access is not available.
- Complete Payment using PayPal or pay E-mailed Invoice within 24-hours of your appointment.
- You may schedule your appointment online using the Schedule Now Button. Please allow 24 – 48 hours for a response.