Omega Institue, LLC.

The Omega Institute Consultation Application Form

For our potential clients, we offer the option of a free telephone consultation. Should you or someone you know have a question about us or would like to utilize one of our services, you may fill out the form below and one of our representatives will contact you at the requested time. The fields marked "*" are requited.

The information submitted with this form will be kept strictly confidential.
Once we have received your completed form, we will contact you via email to confirm your appointment time.

PLEASE NOTE: YOU MAY ALSO FAX THIS DOCUMENT TO US AT 210-805-0828 (US OFFICE) or +86-10- 62806310 (CHINA OFFICE).

Briefly describe what you would like to discuss with us (please include whether you are a student, business, or institution).


    PERSONAL INFORMATION

    *E-mail

    *First Name

    *Last Name

    *Gender

    *Phone Number

    Fax Number

    How did you hear about us?

    Street (and Apt. Number if applicable)

    City

    State

    ZIP or Postal Code

    *Country

    Please note that appointments are normally available beginning between 9:30 am and 4:30 pm weekdays central US time (-6 GMT), or between 8:30 am and 4:00 pm weekdays in China (+8 GMT). Appointments normally take a half hour or less and can begin on the hour or half hour. Furthermore, you may reach us using any of our contact information here.

    Appointment Time Request #1

    Appointment Time Request #2

    Appointment Time Request #3

    Please indicate the best phone number for OI staff to contact you during the business day (9 am to 5 pm central US time or 8 am to 4:30 pm China time). Please note that in order to ensure your privacy, should we call the number, we will not reveal why we are calling.

    PLEASE READ THE FOLLOWING AND TYPE "YES", IF YOU AGREE,
    BEFORE SUBMITTING THIS FORM

    I understand that a telephone consultation is for information purposes only. I will not solicit another product or service via this consultation. All information that I obtain from this consultation cannot be used or proliferated without the expressed written consent of the Omega Institute. The Omega Institute is not obligated to schedule a consultation with me.

    Do you agree? (Yes or No)