PLEASE DO NOT USE THIS FORM FOR CORRESPONDENCE. THIS FORM IS FOR RECEIVING ADDITIONAL TRAINING INFORMATION FROM US. CORRESPONDENCE CAN BE SENT TO CONTACT@FREQUENCYSPECIFIC.COM THANK YOU. First Name* Last Name Name First Name Last Name E-mail* I am a: (choose best answer)* Medical PractitionerMedical StudentPatientHolistic Medicine Enthusiast Type of Practitioner Credentials - APCredentials - BSNCredentials - CACredentials - DCCredentials - DMDCredentials - DOCredentials - DOMCredentials - DVMCredentials - FNPCredentials - LAcCredentials - MDCredentials - NDCredentials - NPCredentials - PACredentials - PTCredentials - RNCredentials - VMD Type of Practitioner DCMDNDPTLMTDORNODOTLAcDPTCNHPDOM Country* United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Turkish Republic of Northern Cyprus Northern Mariana Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic of the Congo Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia South Sudan Spain Sri Lanka Sudan Suriname Svalbard eSwatini Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Transnistria Pridnestrovie Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands Isle of Man US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Street Address City State Zip Mail Address: How did you hear about FSM? (please check ALL that apply)* Referral (please tell us who referred you below)Conference (please tell us which one below)WebinarRead The Resonance Effect BookRead FSM in Pain Management TextbookGoogle SearchTwitterEmail List MemberFacebook AdFacebook PageYouTube VideoTownsend Letter Magazine Who referred you to Frequency Specific? What topics are you most interested in? (choose up to 3) How Does FSM Work?Who Can Learn & Use FSM?FSM Training OptionsTime & Costs To Start Using FSMIncreasing ATPNerve PainTreating FibromyalgiaChronic Pain - (Myofascial Pain, Scar Tissue, Disc, Facet, Ligament laxity, Shoulder, Knee, Arthritis...)Post-surgical RecoveryPTSDShinglesNeuropathic PainRSD / CRPSSports Injuries & EnhancementReducing InflammationScar Tissue and AdhesionsEquipment Used For FSMCEU's - Continuing Education UnitsVestibular InjuriesThalamic Pain SyndromePeripheral NeuropathiesDigestive - (IBS, Chrohn's, UC)Gallbladder, GoutSkin Anti-agingKidney & Kidney Stone PainReproductive System (Ovary, Uterus, Prostate)Respiratory System (Asthma, Bronchitis, COPD)Cardiovascular System (CAD, CHF)Endocrine System (Adrenals, Thyroid, Breast)Acupuncture to FSM Translation Mail Information Packet To: Street Address Street Address Line 2 City State / Province Postal / Zip Code I would like information on how FSM can help with: (choose up to 3) Anti AgingAchilles TendinitisAdhesionsAsthmaBack PainBell's PalsyBenign Prostatic Hypertrophy (BPH)BronchitisCarpal TunnelChronic Regional Pain SyndromeConcussionEmotional IssuesEndometriosis Fibromyalgia Associated With Cervical Spine InjuryFibrosisFracturesFrozen SholderGoiterGoutHerpesInflammationInterstital CystitisIrrital Bowel SyndromeKidney Stone PainLymphedemaMigraine HeadachesMyofascial PainOsteoarthritisNerve PainNeuromuscular Pain And InflammationPeripheral NeuropathyPost-Herpetic Neuralgia Post Surgical PainPost Traumatic Stress DisorderReflexive Sympathetic Dystrophy (RSD)Restless Leg SyndromeScar TissueSciaticaShinglesSinusitisSpinal Disc PainSports InjuriesSprains/StrainsTemperomandibular Joint (TMJ)PainTendon and Ligament Injury or PainTension HeadachesTennis ElbowVulvodyniaWhiplashWound Healing Note Send me updates on future events . Updates Send me updates on future events Submit Should be Empty: