Please read and agree to the statements below before finalizing booking.

First Name *

Phone *

Email *

This is meant as an introduction to our methods here at Dr. Trish Leigh & Co. and a way for you to get your questions answered, find out if this is a viable option for you and for us to determine if you are a good candidate for care. *

Sounds Good

What Service are you interested in? *

Anxiety, ADHD/ADD, and Depression

Explicit Matter (Pornography, Sexual Addiction)

SAD Sexual Arousal Dysfunction (Erectile Dysfunction)

Neurofeedback Experts for Professionals

Sanity After Betrayal (For Partners)

What is the primary challenge you are experiencing? *

Please Input

Relieve the Stress & Anxiety in my life
Improve Focus and Concentration
Resolve Screen Brain Syndrome (social media, YouTube, etc.)
Resolve Addiction (pornography, sexual, explicit content, etc.)
Resolve Sexual Arousal Dysfunction
Improve Neurodevelopmental Disorder
Improve Neurodegenerative Disorder
Autoimmune Disorder
Air Quality Illnesses
Other
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Are you living with any of the following symptoms? *

Anger and/or Emotional Outbursts

Anxiety and/or Stress

ADHD Symptoms (Attention, Concentration, Focus)

Fatigue/Sleep

Pain

Heal Past Trauma (Emotional or Physical)

Sexual Arousal Dysfunction (Erectile Dysfunction)

Depression

No motivation

Compulsive/Addictive Behaviors

Processing issues

Chronic Illness

Other

How long have you been living with these symptoms? *

0 - 1 year

1 - 5 years

5+ years

How important is it for you to solve this issue? *

It’s something I’m exploring, but not urgent right now.

It’s important, and I’m looking for the right solution.

It’s a top priority—I’m ready to take action and invest in a solution.

How did you hear about Dr. Trish Leigh? *

Friend / Family Member

Facebook

Instagram

Google

Podcast

TikTok

YouTube

Other

Anything Else You Would Like To Tell Us Before Your Consultation? *

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