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COUNSEL-ME-ONLINE

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Rise above the muck and mire of life, and swim in the cool, clear spring waters.  -- D L Robbins
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Please Provide the Following Information, to be used for private, secure file purposes only.  This information will not be sold, nor distributed elsewhere. 
 
 

FIRST NAME/NICKNAME:
AGE:
CONTACT EMAIL ADDRESS:
PHONE#: (Optional):
TOPIC#1:
TOPIC#2 (Optional):
EMERGENCY PHONE#:
EMERGENCY CONTACT NAME:
WHAT RELAXATION METHODS WORK FOR YOU?
ARE YOU UNDER A DOCTOR'S CARE, NOW?
  

Please click "SUBMIT" to pass information to my email site, immediately above, and to the right. 
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>^^^^^^^^^
IF YOU ARE PLANNING ON HARMING YOURSELF OR SOMEONE ELSE, THEN PLEASE DIAL "911" NOW!!
There is no time to waste, & YOU are too important to waste!!
 
 
TO SET UP YOUR FREE ASSESSMENT NOW, JUST CLICK "CONTINUE",  BELOW, AND I WILL GET BACK TO YOU SHORTLY.  THANK YOU FOR VISITING THIS WEBSITE.  AND .... PLEASE TAKE CARE OF YOURSELF, AND OTHERS, UNTIL THEN. 
 
 

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