Self-Assessment Form

Self-Assessment Form for Stress and Chronic Pain

The Total Relief Method is best suited for people that are suffering from stress, anxiety, chronic pain, brain trauma or those that are looking to recover faster from acute injury or surgery. We know you have a lot of questions about stress and chronic pain and what solutions are directly available for you. Please take a moment to fill out our self-assessment form below and one of our Certified Calibrationists will get back to you within 24 hours and let you know how or if we can help you specifically. There is no risk or obligation whatsoever and please remember that the Rubenstein Method comes with a money-back guarantee—you will feel better or you don’t pay.

Use the form below to provide the details of your stress and/or chronic pain. Please be as detailed as possible. If you have been diagnosed with something or if you are taking prescription medication or non-prescription medication please let us know as well.

We also have an online stress test that measures your predisposition for excess stress hormone production that you can take here.

[contact-form-7 id=”117034″ title=”self-assesment”]