Full Name
Email
*
Phone
*
Brief description of your situation
*** Terms, Conditions, and Privacy Authorization ***
By checking this box, I confirm that I have read and agree to the Terms & Conditions and authorize the secure use of my information by Brae Scientific (The Brae Applications LLC) for wellness program support. I acknowledge that Brae Scientific may share my information with program-affiliated wellness or healthcare professionals as needed and in compliance with applicable privacy and HIPAA standards. I understand that the AI Coach is not a licensed medical provider and that this service is not for emergencies. If I require immediate medical attention, I will call 911.
*** SMS Consent *** By checking this box, I give my explicit consent to receive text messages from Brae Scientific (The Brae Applications LLC) related to my wellness program, including coaching check-ins, reminders, progress prompts, and supportive educational content. Message frequency may vary. Standard message and data rates may apply. This consent is not a condition of purchase or participation. I may opt out at any time by replying STOP, or request help by replying HELP.
Submit Form