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Bring Kevin Hogan
to your Company




2017
Kevin Hogan
All Rights Reserved





E-Mail Us

Kevin AT KevinHogan.com






Kevin Hogan
Network 3000 Publishing
3432 Denmark #108
Eagan, MN 55123
(612) 616-0732








Teleconsulting for Tinnitus
with Kevin Hogan, Psy.D.

For the first time in a decade, you can have private session(s) with Kevin Hogan to get help with reducing the volume and distress from tinnitus.

Fill in all information on the form you'll find below, click submit at the end of the form. You will be sent a confirmation e-mail. Thank you!

Note on Terms: $750 for your initial session of 90 minutes. All subsequent sessions are 60 minutes long.
Five sessions subscribed to in one block $2500
Ten sessions subscribed to in one block $4500

Exceptions to fees for any of the above: none.

Tele-consulting for Tinnitus - a Private Consultation with Kevin Hogan

Note: After your application is accepted, you will be contacted via e-mail to schedule your tele-therapy session(s). Your credit card will not be charged until your application is formally accepted.

Please note: Although it is most unlikely that you will experience any problems responding to this form, certain non-standard browsers will not respond properly. If you experience any difficulties, (or if you are not using a forms-capable browser) you may email your response to this form to: Kevin AT KevinHogan.com.

First & Last Name:

Email Address:

Telephone:

Street #1:

Street #2:

City:

State:

ZIP/POSTAL:

Country:

Tele-therapy Pricing : $750 Initial 90-minute session. See below for choice of session blocks.

Please submit my application with the following option (choose one):


I am applying for one (1) session of Tinnitus Tele-Therapy - a private 90 minute session on the telephone with Kevin Hogan. Charge my credit card $750 upon acceptance. By checking this box and submitting this form, I am agreeing to the terms of this consultation.



OR

I am applying for a block of five (5) sessions of Tinnitus Tele-therapy. The initial session will be 90-minutes long, with subsequent sessions being 60-minutes long. Charge my credit card $2500 upon acceptance. By checking this box and submitting this form, I am agreeing to the terms of this consultation.



OR

I am applying for a block of ten (10) sessions of Tinnitus Tele-therapy. The initial session will be 90-minutes long, with subsequent sessions being 60-minutes long. Charge my credit card $4500 upon acceptance. By checking this box and submitting this form, I am agreeing to the terms of this consultation.



Terms: Session times as described above. Once your application is accepted, you will be contacted via e-mail within 1-2 weeks to schedule your session(s). On the day of your session(s), you will be expected to telephone the number you are given promptly. Session fees are non-refundable, except as described in the terms below. A session may be re-scheduled one time, and if you ever do not telephone within five (5) minutes of a session start time, the session will be considered canceled on your part, and no fees will be refunded. You will be expected to use a landline (wired) telephone, or otherwise excellent working equipment, with good sound quality.


Check all that apply:

Pulsatile tinnitus Severe

Pulsatile tinnitus Moderate

Whole Tone tinnitus Severe

Whole Tone tinnitus Moderate

Other sounds Severe

Other sounds Moderate

Hyperacusis Severe

Hyperacusis Moderate

Current Hearing: (Type One) Perfect, Near Perfect, Good, Fair, Poor, Deaf One Ear, Deaf Both Ears

Have Cochlear Implant

Suffering from:

Depression Severe

Depression Moderate

Anxiety Severe

Anxiety Moderate

Panic Attacks Frequent

Panic Attacks Irregular

Complex Personal Issues like divorce or recent death of loved one? Y/N:

How long have you had tinnitus? Describe.

What was the circumstance of the onset of your tinnitus?

Had you ever experienced tinnitus prior to onset? Y/N:

We Accept All Major Credit Cards

Payment Method:

Master Card
Visa
American Express
Discover
Check/Money Order
For Credit Card Orders:

Credit Card Number:

Expiration Date:

3 or 4 digit security code:

Name as it appears on card:

Total to Charge Today:

If the Billing Address on your credit card statement is different from the one you gave above, please type it below.

Please answer thoroughly:

Why have you contacted me instead of one of the thousands of other people who might be able to be helpful for you?

I understand that the local time for a teleconsult with Kevin Hogan could begin at almost any hour of the day or night. I understand that Kevin Hogan is not a Medical Doctor and cannot prescribe medication. I give my permission for Kevin Hogan to consult with my Medical Doctor on his own time if he feels it necessary. I give Kevin Hogan permission to consult with my Professional Licensed Therapist if he feels it necessary.

I understand that Kevin Hogan has not taken clients for several years now and at any moment may decide to cease taking clients and stop working with current clients. If this occurs, a prorated refund of session fees will be made. I understand that if Kevin Hogan determines he can't help me that a prorated refund of future session fees will be made. I will not ask Kevin Hogan to break any laws in an effort to help me improve.

I have read the above and check this box as my understanding the above information. Initials:

I do not hold Kevin Hogan responsible or liable in any way for actions I take in treating my tinnitus or results from consulting with him. I have the capacity, desire and interest to make my own decisions and will consider Kevin Hogan's strategy as options. Initials:

I understand Kevin Hogan will never recommend herbs, vitamins,or remedies. Initials:

I understand Kevin Hogan does not accept medical insurance but if we enter into a session block that he will, at my request, fill out insurance paperwork for possible reimbursement, after the fact. Initials:

I will not ask Kevin Hogan to contact my insurance company, Medical Doctor or any other therapist. Initials:

I understand Kevin Hogan no longer regularly practices therapy and therefore am working around his business schedule. Initials:

I understand Kevin Hogan makes no promises, guarantees that my tinnitus will remit 100%. Initials:

I understand that getting well from tinnitus takes time. Initials:

I understand Kevin does not ever take phone calls from clients, except at the scheduled time. Initials:

Please enter any special considerations about you that you want Kevin to know about. Kevin receives thousands of requests per year and can only agree to help a very small percentage of those inquiring.

Your application will be reviewed within four days.

Your credit card will not be charged until you have been accepted. Once accepted you will be given an available time slot, typically within 1-2 weeks.

You will be contacted by e-mail regarding the acceptance of your application. Kevin Hogan retains the right to turn down any application for any reason. No charges will be made to your credit card until acceptance is complete.


Important: If accepted, your charge will appear as "Network 3000" on your statement!

Fill in all information, click submit at the end of the form. You will be sent a confirmation e-mail. Thank you!


If you'd prefer not to send your credit card number over the internet, you can call our headquarters, 24 hours per day at

(612)616-0732.

Have all of your ordering and credit card information ready to leave on our secure voicemail system.

If you do not have MasterCard, Visa, Discover or American Express, you can still register from this page! Just fill out the appropriate sections and submit this form. Then simply mail a check or money order(payable to: Network 3000) to:

Network 3000,
3432 Denmark Ave. #108
Eagan, MN 55123. Your order confirmation will be sent upon receipt.






Kevin Hogan
NETWORK 3000 Publishing
3432 Denmark #108
Eagan, MN 55123
(612) 616-0732




Private Sessions

Apply On This Page
One 90-min. Session $750
Five Sessions $2500
Ten Sessions $4500

Tinnitus Teleconsult