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Payment Form 
Please complete to purchase Health Coaching Sessions or Physical Therapy Services
Health Coaching Plan Options and
Physical Therapy Services:
Select an item ($)
Payment
Options:
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Zelle, Apple pay or Venmo
*If you prefer payments for your plan agreement, ask me about:
Zelle, Apple pay or Venmo options

 
Zelle, Apple pay or Venmo

Thank you for submitting this form!

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