Nutrition & Functional Medicine Practitioner
Please note: this is an anonymised sample initial consultation report produced for illustrative purposes. Names and personally identifying details have been removed. The clinical history, test results, working hypothesis, investigation plan, and supplement protocol are representative of an actual first appointment at PFoley Clinic and show exactly what a new client receives after their initial consultation.
Thank you for the time you took today — and for going through the full history. It is clear that this has been a long road. Seven or eight years of symptoms. Multiple practitioners. Interventions that have either done nothing or produced only partial, temporary shifts. I want to acknowledge that before anything else: what you have been through is not a failure of effort on your part. It is a failure to identify and address the actual mechanisms driving the problem.
The clinical picture is coherent. You came in with test results that already confirm the core of it — Citrinin mycotoxin at four times the upper limit of normal, significant gut dysbiosis, and a high-grade yeast reactivity. Layer on top of that the mould exposure history (over a decade, with the bedroom identified as the primary site), the jaw and sinus symptoms, the persistent mucus, and a nervous system that has been in a low-grade threat state for years — and the picture comes together clearly. This is not mysterious. The body is reacting to a sustained toxic and microbial load that has never been fully addressed at source.
The reason previous interventions underdelivered is also clear: the source of the exposure was not dealt with, and the protocols used were not comprehensive enough for the systemic load you are carrying. Addressing one piece — supplements alone, or diet alone — without attending to the environment, the nervous system, and the gut simultaneously is not enough. The approach here is different: we work all of it at once, in a staged sequence that does not overwhelm the system.
Phase 1 starts today. The objectives are targeted and specific: begin the detox support protocol, reduce systemic inflammation via LDN, start the mycotoxin-binding pathway, and complete the Visual Contrast Sensitivity test to confirm and baseline the biotoxin picture. The supplement list is intentionally lean at this stage — five items, each with a clear mechanism. We build systematically from here.
The bedroom environment is non-negotiable from day one. It is part of the medical treatment. Every supplement you take works against an ongoing exposure source if that source remains. We address them in parallel.
Your next review is in 6–8 weeks. We will assess the VCS result, any early symptom shifts, and adjust the protocol accordingly. Any questions before then, email through directly.
Your stated goals: to breathe properly through the diaphragm (specifically to enable singing), resolve fatigue, eliminate bloating and the bowel difficulties, clear the tinnitus, and understand what has been causing this for so many years. The clinical priority this phase is to confirm the biotoxin picture, begin the detox and anti-inflammatory foundation, and address the bedroom environment.
Your MSQ score at this first consultation is 68. The dominant inputs are energy, nasal and sinus burden, muscle weakness, and cognitive symptoms. This score is the benchmark — every follow-up will record a new score and compare it to 68. In comparable mould-recovery cases, scores typically halve within 3–6 months of comprehensive treatment. The target is below 10.
The history tells a coherent story when read in sequence. You moved into a mould-affected property in 2013 — visible mould on the ceiling from the start, and a significant amount of black mould discovered behind bedroom furniture years later. Symptoms began around 2017–2018, approximately four to five years after the initial exposure. This delay is clinically typical of chronic mould illness: the early phase is a slow accumulation of biotoxin load without acute symptoms. By the time symptoms become undeniable, the body has been mounting a sustained immune and inflammatory response for years.
You have since moved to a cleaner environment, but the current bedroom still shows condensation, occasional mould growth at the window and in a corner, and has a history of water dripping from the attic. This is not a resolved exposure — it is an ongoing one at a lower level. Without addressing it, the recovery ceiling is limited regardless of protocol quality.
Three previous practitioners. A chiropractor, two nutritionists. The chiropractor addressed posture — a genuine secondary issue — but posture is not the cause of breathing restriction in this case. It is a consequence of the nasal/sinus obstruction and the muscular pattern that developed around chronic jaw tension. Correct the underlying cause and the posture follows; treating posture alone without the underlying driver produces limited change.
The first nutritionist identified the mycotoxin elevation — the right finding — and provided a detox plan. No noticeable improvement. The most likely explanation: a detox plan without a comprehensive antifungal and elimination protocol, and without addressing the exposure source in the bedroom, works against an ongoing load. You cannot effectively detox while re-exposing continuously. The second nutritionist added supplements and dietary adjustments. Again, partial approach — the systemic nature of the problem (gut, limbic system, nasal/MARCoNS, bedroom environment, and cellular energy) requires all layers addressed simultaneously and in the right sequence.
This is why comprehensive, staged functional medicine produces results where piecemeal approaches do not.
1. Mould toxicity (Citrinin — confirmed). Citrinin at 104 ng/g creatinine is four times the upper limit of normal. Citrinin is produced by Penicillium, Aspergillus, and Monascus moulds — exactly the species found in damp indoor environments. It is nephrotoxic, increases mitochondrial membrane permeability in the kidneys, suppresses immune response, and has been shown in multiple studies to impair cellular energy production. This single finding explains the fatigue, the cognitive symptoms, the weakness, and the elevated immune activation at the gut level. The bedroom is the likely ongoing source.
2. Gut dysbiosis (confirmed on stool analysis). The stool analysis shows a red-flag dysbiosis pattern: very low Prevotella and other butyrate-producing bacteria, elevated pathogenic species. This is the gut immune activation sitting beneath the surface — inflamed gut lining, poor nutrient absorption, and a sustained sIgA response. The yeast high-reactivity on food intolerance testing (28, well into the high-reactivity bracket) is consistent with yeast overgrowth as a co-driver of the gut environment. All yeast-containing foods are out immediately.
3. Suspected MARCoNS. The combination of persistent mucus at the back of the throat, jaw and sinus tension, and the mould exposure history raises a strong clinical suspicion of MARCoNS — Multiple Antibiotic Resistant Coagulase Negative Staphylococci — in the nasal passages. MARCoNS is a biofilm-forming organism that produces its own biotoxins and directly contributes to the Visual Contrast Sensitivity deficit we see in mould illness. It also connects to the breathing restriction: chronic sinusitis and nasal obstruction, driven in part by a MARCoNS colony in the upper respiratory tract, forces a shift to chest breathing. The VCS test ordered today will help confirm this picture; the nasal protocol starts at Phase 2 once we have a clearer baseline.
4. Limbic system dysregulation. After years of chronic illness, early adverse experiences in childhood, and a nervous system that has been running on high alert, the limbic circuit — the brain's threat-assessment system — becomes hyper-sensitised. It starts producing and amplifying symptoms independently of the original triggers. This is not psychological; it is a well-documented neurological pattern in mould illness and chronic fatigue. DNRS (Dynamic Neural Retraining System) addresses this layer specifically. It is not optional — it is a core component of the protocol.
The bedroom environment must change this week. Dehumidifier installed and running at night. New mattress and bedding ordered. Mould-proof paint on the affected walls. Check for any active roof or attic leak and address it. Without this, every other intervention works against an ongoing exposure. This is not a lifestyle recommendation — it is medical treatment.
You arrived at this consultation with results from testing completed prior to our appointment. These are interpreted below in the context of your full clinical history. One investigation has been ordered today — the VCS test — to complete the initial picture.
Mycotoxin Profile (Urine — Great Plains Laboratory)
| Metabolite | Result | Reference | Status | Clinical Interpretation |
|---|---|---|---|---|
| Citrinin (DHC) | 104.25 | <25 | 4× High | The headline finding. Citrinin (Dihydrocitrinin DHC) at 4× the upper limit confirms significant active or recent mould exposure. Produced by Penicillium, Aspergillus, and Monascus species — the exact moulds associated with damp indoor environments. Citrinin increases kidney mitochondrial membrane permeability (nephrotoxic), suppresses immune function, and has documented effects on cellular energy production. The bedroom water history is the most likely ongoing source. This result validates the clinical picture and directs the entire Phase 1 protocol. |
| All other mycotoxins | Within range | Various | Clear | Aflatoxin-M1, Ochratoxin A, Gliotoxin, Sterigmatocystin, Mycophenolic Acid, Roridin E, Verrucarin A, Enniatin B, Zearalenone, Chaetoglobulin A — all within normal range. The mycotoxin burden is specific to Citrinin rather than a broad multi-mould picture. This is consistent with a single primary environmental source (the bedroom) rather than widespread building contamination or dietary mycotoxin load. |
Stool Analysis
| Finding | Result | Expected | Status | Clinical Interpretation |
|---|---|---|---|---|
| Overall dysbiosis pattern | Red flag | Balanced | Dysbiosis | The stool analysis shows a dysbiosis pattern graded as red — the most significant tier. This means the balance between commensal (beneficial) and pathogenic bacteria is significantly disrupted, with pathogenic species elevated and the beneficial species depleted. |
| Prevotella | Very low | Adequate | Very Low | Prevotella is a key butyrate-producing genus — one of the primary commensal bacteria responsible for producing short-chain fatty acids that feed the gut lining, maintain colon pH, and regulate the immune response. Very low Prevotella directly explains the alkaline stool pH, the bloating, the bowel transit difficulties, and the background gut immune activation. Heavy antibiotic history (including Metronidazole for Blastocystis) is a likely contributing factor to this depletion. |
| Butyrate-producing bacteria | Low | Adequate | Low | Consistent with the Prevotella finding. Low butyrate production means the colonocytes (gut wall cells) are fuel-deprived. This permits increased gut permeability, inflammatory signalling, and impaired immune regulation — all of which drain energy and sustain the symptom burden. |
Food Intolerance Panel
| Food | Score | Reference | Status | Clinical Interpretation |
|---|---|---|---|---|
| Yeast | 28 | <20 high reactivity | High Reactivity | The highest-priority food finding. A yeast reactivity score of 28 in the high-reactivity bracket confirms both the gut immune activation and the likely presence of yeast overgrowth as a co-driver of the dysbiosis picture. All yeast-containing foods are out immediately and remain out until the food intolerance panel normalises. This includes bread, beer, fermented foods, vinegar, aged cheeses, and anything with "yeast extract" on the label. Yeast feeds the same organisms we are targeting with the antifungal protocol — dietary elimination is a direct therapeutic intervention, not optional lifestyle advice. |
| Cow's Milk | 19 | 12–19 borderline | Borderline | At the upper edge of borderline. The lactose intolerance noted in your intake form is consistent with this. All dairy is out under the SIBO maintenance diet regardless — this result confirms the decision. May be revisited once gut integrity is restored. |
| All other foods | 0–8 | <12 normal | Normal | No high or borderline reactivity to other tested items. Eggs are clear and remain a primary protein source on the protocol. |
SIBO Breath Test (2020)
| Test | Result | Reference | Status | Clinical Interpretation |
|---|---|---|---|---|
| SIBO Breath Test | Negative | Negative | Negative | Small intestinal bacterial overgrowth was not confirmed in 2020. The stool dysbiosis picture above is primarily a large bowel (colonic) pattern rather than a small intestinal one. The SIBO maintenance diet remains the appropriate dietary framework — it minimises fermentable fibres that feed both yeast and colonic pathogenic bacteria regardless of SIBO status. |
Investigation Ordered Today
| Test | Result | Reference | Status | Notes |
|---|---|---|---|---|
| Visual Contrast Sensitivity (VCS) — vcstest.com | — | Pass | Ordered | The VCS test is an online test (£8 at vcstest.com) that measures the visual system's ability to detect contrast across spatial frequencies. Biotoxins from mould, MARCoNS, Lyme, and other biotoxin-producing organisms preferentially damage the visual contrast pathways. A positive (failing) result confirms active biotoxin burden and is one of the most sensitive clinical indicators of mould illness and/or MARCoNS. Complete this test today and bring the result to your follow-up. It baselines the biotoxin load and will be repeated monthly to track clearance. |
All Natural Dispensary items can be ordered in one order to save on delivery.
| Natural Dispensary | naturaldispensary.co.uk | Use code PFC10 |
| Amrita Nutrition | amritanutrition.co.uk | Use code YJHPH3 |
| Piping Rock | pipingrock.com | No code — competitive pricing |
Phase 1 has one clinical priority: open the detox and anti-inflammatory pathways without overwhelming the system. LDN reduces the neuroinflammatory and immune burden. The Lactobacillus blend physically binds Citrinin and other mycotoxins in the gut, preventing their reabsorption. Bind & Broom captures and eliminates toxins via stool. Quercetin reduces mast cell activation and histamine load — a common amplifier of symptoms in mould illness. Ubiquinol supports the mitochondrial energy chain that Citrinin is directly impairing. Five supplements. Each with a clear, specific mechanism. This is the foundation everything else is built on.
Daily Schedule — Phase 1
| Supplement | A.M. | B'fast | Mid | Eve | Bed | Note |
|---|---|---|---|---|---|---|
| Bind & Broom | ✓ | On waking. 2 hrs away from supplements. Start with tiny amounts of each. | ||||
| Lactobacillus blend | ✓ | Take 20–30 min before breakfast for best colonisation. | ||||
| Quercetin Complex | ✓ | ✓ | ✓ | 1 cap × 3 daily with food. Take before and after meals if histamine is a strong driver. | ||
| Ubiquinol | ✓ | 1 daily with the fattiest meal of the day for absorption. | ||||
| LDN | ✓ | As prescribed. Evenings preferred. Switch to morning if sleep is disrupted. |
Phase 1 Supplements — Full Detail
| Supplement | Dose & Timing | Purpose | Status |
|---|---|---|---|
LDN (Low Dose Naltrexone) Prescription — hypoallergenic compounded version essential. Via GP or private prescriber. See note below. |
As prescribed by the prescribing physician. Best taken evenings. If sleep is disrupted, switch to mornings. | Low Dose Naltrexone is one of the most clinically valuable agents in mould illness, chronic fatigue, and autoimmune patterns. It works via the toll-like receptor 4 (TLR4) pathway — reducing neuroinflammation and modulating the immune dysregulation that sustains symptom burden. It is anti-inflammatory without the side-effect profile of conventional anti-inflammatories, and has a strong evidence base in complex chronic illness. Request the hypoallergenic compounded version specifically — some additives in standard formulations can trigger mast cell activation in sensitive individuals. Access via private prescriber — see the LDN Research Trust (ldnresearchtrust.org) for the patient form and prescriber information. | Rx |
Allergy Research Lactobacillus (L. plantarum / rhamnosus / salivarius) 100s Natural Dispensary · code PFC10 |
1 daily. Take 20–30 minutes before breakfast. | This specific strain combination has a mechanism that goes beyond standard probiotic action. L. plantarum C88 and related strains directly bind aflatoxins (especially B1) and sterigmatocystin in the gut lumen, preventing their reabsorption. They also upregulate the antioxidant activity of glutathione S-transferase — the primary enzyme in Phase II liver detoxification of mycotoxins. In a Citrinin-burden case, this is as much a detox supplement as a gut supplement. The pre-breakfast timing maximises the bacterial colonisation window. | Start |
Bind & Broom — Plasma Pudding Components: Psyllium husk (Amazon) · Activated charcoal powder (Amazon) · Bentonite clay powder (Amazon) |
Mix 1 tbsp psyllium husk + 1 tbsp activated charcoal + 1 tsp bentonite clay in a large glass of water. Take on waking, empty stomach. Always follow with a second glass of water. Keep well hydrated throughout the day. Start with very small amounts of each and build up gradually over 1–2 weeks. | The Bind & Broom combination physically captures toxins — including Citrinin and other mycotoxin metabolites — in the gut lumen before they are reabsorbed into the bloodstream. Psyllium husk provides bulking and carries the binders through the gut; activated charcoal adsorbs lipophilic toxins including mycotoxins; bentonite clay adsorbs heavy metals and additional mycotoxins through an electrostatic binding mechanism. Must be taken a minimum of two hours away from all medications and supplements, as it will bind them too. Starting slowly prevents detox reactions from rapid toxin mobilisation. | Start |
Quercetin Complex (G&G) Natural Dispensary · code PFC10 |
1 capsule × 3 daily with food. For histamine support: take 1 capsule before and after each main meal. | Quercetin is one of the most clinically validated natural mast cell stabilisers — it inhibits the release of histamine and other inflammatory mediators from mast cells without the drowsiness of pharmaceutical antihistamines. In mould illness, mast cell activation and histamine excess are extremely common and explain the mucus production, the nasal congestion, the brain fog, and the symptom flares after certain foods. Quercetin also has direct antioxidant activity relevant to the oxidative burden from Citrinin exposure, and has documented anti-inflammatory effects via NF-κB inhibition. The G&G Quercetin Complex formulation is chosen for its bioavailability — quercetin is poorly absorbed in basic forms. | Start |
Ubiquinol 200mg Piping Rock — pipingrock.com |
1 daily with the fattiest meal of the day. | Ubiquinol is the active, reduced form of CoQ10 — the electron carrier in the mitochondrial electron transport chain, the final step before ATP production. Citrinin specifically impairs the integrity of mitochondrial membranes; ubiquinol supports both the membrane structure and the energy-generating function simultaneously. At 200mg, this is a therapeutic dose appropriate for someone whose mitochondrial function is under active load. Take with a fat-containing meal — ubiquinol is fat-soluble and absorption drops significantly without dietary fat. Piping Rock offers a quality formulation at a competitive price point. | Start |
Get a large 7-day pill box and fill it once a week. If taking supplements three times daily, get two boxes. This turns a daily decision into a weekly five-minute task and dramatically improves consistency. ASDA and most supermarkets sell suitable pill boxes. Consistency over the first four to six weeks is the single biggest determinant of early protocol success.
The SIBO maintenance diet is not about weight loss or restriction for its own sake. It is a targeted framework that removes the dietary inputs that feed yeast (confirmed high-reactivity), pathogenic bacteria (confirmed on stool analysis), and the fermentable fibres that produce the bloating and bowel difficulties you have been experiencing. Get a slow cooker and start using it. Slow-cooked red meat (beef, lamb), soups, stews, and meatballs are the easiest practical format for this protocol — high protein, low fermentable carbohydrate, easy to batch-cook, and genuinely therapeutic for gut lining repair. Bone broth is medicine here, not just food.
The key restriction to understand: no yeast, no dairy, no grains except basmati or jasmine white rice (½ cup per serve). These three exclusions drive the majority of the gut symptom improvement in weeks 2–4. Everything else follows the table below.
| Category | Eat freely | Avoid until further notice |
|---|---|---|
| Protein | All meat · fish · poultry · eggs. Slow-cooked red meat is ideal — batch cook once or twice a week. | |
| Dairy | Coyo coconut yoghurt · Grace coconut milk · almond or coconut milk (unsweetened, no additives) | All conventional dairy — milk, cheese, butter, cream, yoghurt. Borderline on food intol test + SIBO protocol both exclude it. |
| Vegetables (free) | Bamboo shoots · bok choy · carrot · chives · cucumber · aubergine · ginger · kale · lettuce · olives · capsicum · rocket · spring onion (green part) · tomatoes / sundried · sunflower sprouts · alfalfa sprouts · parsnip | Potato (white or sweet) · starch powders · canned vegetables · onion · garlic · mushrooms |
| Vegetables (limit to 1 serve per meal) | Asparagus · artichoke · beet · broccoli · Brussels sprouts · butternut · cabbage · cauliflower · celery · chilli · fennel · green beans · peas · pumpkin · leek · spinach · zucchini | |
| Fruit | Banana · citrus · all berries · kiwi · rockmelon · honeydew · pineapple · passionfruit · avocado · cherries · grapes · lychee · pomegranate. Introduce one at a time and track tolerance. | Canned fruit · apple · apricot · fig · mango · nectarine · peach · pear · watermelon — review after Phase 2 |
| Grains | Basmati or Jasmine white rice only — ½ cup per serve maximum. Do not cut this entirely — it is your primary carbohydrate and energy source within this protocol. | All other grains · all bread · pasta · oats · cereals · cakes · biscuits |
| YEAST — critical exclusion | None permitted | Everything containing yeast: bread · sourdough · beer · wine · vinegar (except ACV) · fermented foods · nutritional yeast · Marmite · aged cheeses · anything with "yeast extract" on the label. Score of 28 on food intol test — this is a direct driver of your gut inflammation and immune activation. |
| Legumes | Brown lentils (½ cup) · green and red lentils (¼ cup) · Lima beans | All other legumes and beans |
| Broths / soups | Homemade bone broth — beef, lamb, or chicken. Make it a daily habit. It provides collagen, glycine, and glutamine which directly support gut lining repair. Crock pot, 8+ hours. | Commercial stocks · canned soups · anything with onion, garlic, or additives |
| Beverages | Water (1.5L+ daily) · herbal teas · black coffee · black tea | Soft drinks · fruit juices · wine · beer · energy drinks |
| Fats & oils | Coconut oil · olive oil · MCT oil · butter · ghee · avocado oil | Palm oil · soybean oil · seed oils (vegetable, canola, sunflower in large amounts) |
The clinical picture is a multi-system presentation driven by a decade of mould exposure that has never been addressed at source. Citrinin at 4× the upper limit of normal is the confirmed mycotoxin driver — impairing cellular energy, suppressing immunity, and increasing the kidney's workload. The gut is significantly dysbiotic with yeast overgrowth as a co-driver. MARCoNS is clinically suspected based on the nasal, sinus, and jaw picture. And the nervous system has been running in a low-grade threat state for long enough that limbic dysregulation is now a maintaining factor in its own right.
Phase 1 does not try to fix everything at once. It opens three pathways simultaneously — detox (Bind & Broom + Lactobacillus), inflammation reduction (LDN + Quercetin), and mitochondrial support (Ubiquinol) — while securing the environment that has been the source of the problem. The VCS test confirms the biotoxin picture. The follow-up builds from there. This is a staged recovery, not a single intervention — but it starts today.
VCS test result — positive or negative? Score and biotoxin pattern. This determines the pace and intensity of Phase 2 antifungal and nasal treatment.
Supplement tolerance — how are the five Phase 1 supplements sitting? Any reactions to Bind & Broom (constipation if under-hydrated; reduce clay and increase water)? Quercetin well tolerated? LDN accessed and started?
Diet adherence — is the SIBO maintenance diet workable? Has the slow cooker been used? Any noticeably reactive foods within the permitted list?
Bedroom environment — has the dehumidifier been installed? New mattress and bedding? Any improvement in morning symptoms now that the sleep environment is cleaner?
Symptom trajectory — energy, bloating, bowel function, breathing, tinnitus, brain fog. Specific changes, not general impressions.
Phase 2 readiness — if VCS is positive and the Phase 1 foundations are stable, Phase 2 adds the 10-week antifungal pulse, the nasal MARCoNS protocol, Saccharomyces boulardii, Undecylenic Acid, EDTA, Glutathione cream, Lugol's iodine, and Bicarbonate soda. This is the elimination phase — it is more intensive and requires the Phase 1 foundation to be working first.
MSQ rescore — complete at the session and compare to baseline of 68.
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Reference Sheet · Phase 1 · Foundation & Investigation
Your Plan — May 2025
5 supplements · VCS test today · SIBO diet · Bedroom environment · DNRS
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Follow-up review
6–8 Weeks
Contact admin to book
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Do Today — Before This Appointment Ends
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Daily Supplement Schedule — Phase 1
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Environment & Lifestyle
Coming in Phase 2
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Key Dietary Rule
No yeast, no dairy, no grains except basmati or jasmine white rice. Slow-cooked red meat, bone broth, soups and stews. Eggs are fine. Protein at every meal. 1.5L+ water daily. Get a slow cooker — batch-cook once or twice a week.
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Watch — Email Immediately If
Bind & Broom — if constipation worsens significantly: reduce clay first, increase water dramatically. Email if it persists beyond 48 hours.
LDN — vivid dreams or disturbed sleep in the first 1–2 weeks is common and usually settles. If it persists beyond 2 weeks: switch to morning dosing. If other significant side effects: email. Detox reactions — some clients experience a brief worsening of symptoms (headache, fatigue, nausea) in the first 1–2 weeks as toxins mobilise. This is a Herxheimer-type reaction — reduce the Bind & Broom dose temporarily and increase water intake. Email if it is severe or lasts more than 3 days. |
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For Follow-Up — Bring
VCS test result · weekly symptom notes (energy, breathing, bloating, bowel, tinnitus, concentration, sleep) · LDN status (obtained and started, or not) · bedroom environment status · diet adherence notes · any reactions or observations
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Questions Between Sessions
paul@pfoleyclinic.com · pfoleyclinic.com
Any reaction, concern, or question — email through. Don't wait until the follow-up. |