Please fill out the form below to register, once we verify your information we will inform your practitioner, if you don’t have a practitioner, we will help you find one. Client Disclaimer Client Name First Last Email PhoneDo You Already Have a Practitioner?*If You Don't Have a Practitioner...Don't worry, we'll match your symptoms with the right ACT PractitionerYesNoPlease list your symptoms and how long you've had them?*Practitioner Name*Enter your Practitioner info here, if you don't have one, we can help you find a Practitioner.Practitioner Phone Number*Practitioner Email* They will be notified by email that you signed the disclaimer. Disclaimer*Check the I AGREE box below, to agree to the terms on the DISCLAIMER PAGE - CLICK HERE TO VIEW. Disclaimer I AGREE