One on One
Counseling Application

If you're ready to work with me one on one, fill out the form below.

If you are a Mensah Medical patient, click here.

Please read my frequently asked questions before filling out this form.

Your information is secure and confidential. I do not share
with third-parties.

I work in four and eight month increments. I only work via phone (in the US and Cananda) and Skype (if outside the US and Canada).

Please check spam folders if you do not receive a response. We strongly recommend using a free GMail account to avoid high level spam blockers.

Please note I am currently accepting new clients in December.

    Full Name

    What is your age?

    E-Mail Address

    What is your mobile number?

    In what part of the world do you live? (city, state, country)

    Are you a Mensah Medical patient?

    What challenges will keep you from committing to a daily dietary and supplemental regimen?

    Briefly describe the top 3 health challenges you're currently facing?

    Briefly describe what you want to achieve by working with Sami?