Online Consultation Appointment Requests

Online Consultation Appointment Requests

The Svetlana Masgutova Educational Institute is accepting appointment requests for our Online Consultation program.

Appointments will occur over Zoom. You can download Zoom here: https://zoom.us.

Appointments are $200.00 per session.

Appointments will be 50 minutes long. Each additional 5 minutes will cost and additional $25.00.

You must complete the Participation Agreement form in order to participate in the Online Consultation program.

Please note:

*Submitting this request for an online consultation does not guarantee the date or time you requested. We will do our best to accommodate every request.

*We will contact you within 1-3 days after you submit your request to complete registration for your online consultation.

*Questions? Please email Jessica Rife, appointment coordinator, at jessica@masgutovafoundation.org

* : required
Patient Name:*
Patient Date of Birth:*
When was patient's last MNRI assessment?*
When was patient's last MNRI Family Education conference?*
Guardian Name:*
Phone Number:*
Email Address:*
Requested date of Online Consultation (We will do our best to schedule you the requested date or call you to choose one very close to it):*
Requested time of Online Consultation (We will do our best to schedule you the requested time or call you to choose one very close to it):*
What is your goal for your Online Consultation?*

Please complete the visual confirmation*