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Instructions:

Please fill out this form with the information you would like included in your listing. If a field does not apply to you or you prefer not to provide the information, just skip it. Most fields are not “required.” It’s your choice.

If you do not want to include a physical address, that’s fine, BUT we do need the city and state so people can look for practitioners in and around their general location.

We highly recommend uploading your photo. People like to see that you are a real person with a friendly smile! 😉

NOTE: Upon submitting this form you will be redirected to an order form to pay $47 (set up fee).

If you have any questions or issues, please contact: TechSupport@AcademyEpic.com
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Practitioner Listing Form