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Client Application

By completing this client application form, you're helping us determine whether our program is the right fit for you. We'll gather more details as we go, but this initial information gives us a deeper understanding of your needs so we can provide the most helpful answers and next steps.

*Required field

About you

What are your top three (3) symptoms/concerns? (please rate the severity from 1 to 10; 10 being the most severe)

How long do you believe you've had Lyme?
Sex
State

Your privacy matters. We’ll never sell or share your information. You’re here for answers...and that’s exactly what we’re here to provide.

*The Lyme Laser Protocol™ and all variants of the Lyme Laser Protocol™ are a Complementary and Integrative Health Protocol as defined by the National Institutes of Health (NIH). The Lyme Laser Protocol™ is designed to address and alleviate the symptoms of Lyme disease and other chronic illnesses.

​7 Scott Rd, Hampton, NH 03842

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