Contact Us

Use the form on the right to contact me or a contributor. 

 

           

123 Street Avenue, City Town, 99999

(123) 555-6789

email@address.com

 

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Link to read me page with more information.

Register for Meditation with Lee

Register for Meditation with Lee below. Submission of your registration is your commitment to the course and does not result in billing. You will only be charged for the classes you attend and on the days you attend.

Please use this form for the "New Year/New Mind" registration. This is a free event to be held on Saturday, January 6, 2018 at our office in Watertown, NY. The event will last 1.5 hours and is meant to teach mindfulness and promote this healing practice. No further commitments beyond this free session is necessary.

Registration information is sent directly to me. Your submitted information is private, confidential, and secure. If you submit insurance information, this will be shared with our staff.

Once submitted, you will hear back from me within 3 business days. 

Name *
Name
Date of Birth *
Date of Birth
Phone *
Phone
Example: "a flyer", "a friend", "doctor adirondack website"
Symptom Checker *
Levels of stress will be assessed by me (Lee) only. Please share honestly.
If you'd like me to know more about your symptoms and/or struggles, please describe below.