Exam Request

Soiling Solutions encopresis

For Healthcare and School Professionals Only:

Please complete the form below for a brief four page summary of my Soiling Solutions (SS) protocol published by the International Foundation of Functional Gastrointestinal Disorders (www.iffgd.org). The digital copy will be sent to your official institutional email address for download along with a schematic of “The Treatment ‘Hour’ and Four Sits at a Glance.” This will be adequate for most of you. The parents will require the full “Clean Kid Manual 6,” our SS forum, and YOU for success. This will save you much aggravation. Those of you who are not sufficiently knowledgeable about Classical Conditioning theory, suppositories and enemas, or bladder and bowel function should order the digital or bound version of my parent manual with a full refund to follow. You must use your official website’s email address noted on the form below in making the order or a refund will not be honored. Given the lack of success of the current pediatric approach when it fails after 6 months (one year at the most) my manual can become a very much appreciated breakthrough for your patients, parents, and pupils.

Please guess the approximate number of referrals that can be expected to purchase the Clean Kid Manual 6 annually.

Expected Annual Referrals (required):
You agree that parental home use of your exam copy will not be allowed (required).

You agree to have your office or facility listed on my Encopresis Centers list at (www.encopresis.com/encopresis-advice/encopresis-treatment-centers/). I will need your website url and a phone number that goes directly to a receptionist at your facility.

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All non-USA orders must order a digital copy to avoid customs delays or failures. Please make this same point for your English reading parents.

I am interested in special proposals by professionals from non-English speaking countries for distribution of my Clean Kid Manual to be financially viable. This would likely require a translation of the manual into the dominant language of your country which I cannot undertake on my own. Please make a proposal to me using our website contact-us form. DrC.

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