NeuroSoul Intake NeuroSoul Intake (Short Application)First NameLast NameEmailWhatsApp/Phone - Fastest for scheduling.What would you like to change right now?What feels most stuck or costly right now?What have you tried so far?Timeline- Select -Now (0–2 weeks)Soon (2–6 weeks)Later (6+ weeks)Preferred contact method. We’ll use your preference unless email is needed for logistics. Email WhatsAppTime zone (or city)Consent checkbox (required) I understand NeuroSoul is coaching/education, not medical care. I’m responsible for my health decisions and will seek medical support for urgent symptoms.Privacy checkbox (required) I consent to being contacted about my application. My information will be handled privately. We don’t sell personal data.Budget readiness- Select -Ready to proceed if it’s alignedConsidering a serious investmentExploringSubmit Form
