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Client Application

To get started we kindly request that you complete our new client application form.  Please note that the form is quite detailed, but it plays a crucial role in our initial triage process, allowing us to tailor your support to best suit your individual needs

This Spring, we’re offering 0% APR on every 12-month finance option.

On completion of this form, a member of our team will be in touch to book your free, no obligation consultation.

About you

*Required field

State
Sex
How long do you believe you've had Lyme?

What are your top three (3) symptoms? (please rate the severity from 1 to 10; 10 being the most severe)

We will review your medical history, including any documentation, as part of your initial consultation.

Book a free consultation

With our online booking system, you can book your consultation on a date and time that suits you.

​*The Lyme Laser Protocol™ and all variants of the Lyme Laser Protocol™ are a Complementary and Integrative Health Protocol as defined by the National Institutes of Health (NIH). The Lyme Laser Protocol™ is designed to address and alleviate Lyme disease symptoms.

​7 Scott Rd, Hampton, NH 03842

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833.ZAP.LYME (927.5963)

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