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Are you ready to take back your health?

Start the process with our intake application! Please answer each question to the best of your ability. Seeing that you wish to continue the intake process, name, email, and DOB is required at the end of the application.

Please look out for an email from us after completion

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How did you find out about us?

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What service(s) are you interested in starting? ^*

Select all that apply.

Nutrition Response Testing* (a non-invasive system of analyzing the body in order to determine the underlying causes of ill health.)

Myofascial Release Therapy* (a type of therapy that assists in the release of trauma and pain that has been stuck in the tissue of the body.)

Personal Training* (achieving real wellness and a healthy life with the support of a strong physical body)

Other

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Please describe the symptoms you've been dealing with that motivated you to seek a more holistic health approach. ^*

Include any and all symptoms and how they've impacted your life.

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What have you done to manage the symptoms you've been experiencing?

"I went to my doctor and they prescribed me..."
"I purchased herbal supplements off of Amazon that claim to help with..."

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Have you had experiences with other natural health practices?

Acupuncture, chiropractic, functional medicine, reiki, etc.

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How much are you willing to financially invest into your health monthly? ^*

Depending on the service, a natural health approach will require a financial commitment, which will include service payment and any recommended nutritional supplementation, additional therapies, etc.

$100 - $300

$300 - $500

$500 - $800

$800 - $1000

$1000 or more

Other

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How much time are you willing invest? ^*

Depending on the service, we have a strict policy regarding appointment frequency that must be honored seeing that you are committed to a health approach of this nature. Appointment times vary (generally 30 minutes-1 hour).

Appointments twice a week

Once a week

Biweekly (every two weeks)

Few times a month

Once a month

Other

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Are you willing to make changes to your lifestyle? ^*

Yes! I'm ready

I think I can

Maybe

Not right not

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Are you willing to be coached? ^*

Yes! I'm ready

I think so

Maybe

Not for me

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Will the people in your life support your decision in seeking an alternative health solution? ^*

Spouse, partner, family members, children, etc.

100% yes

I think so

I'm not sure

Probably not

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Do you have any apprehensions about natural health practices? ^*

Socially, financially, physically, etc.

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If you feel confident in starting your health journey with us, please provide the information below.

First Name

Last Name

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Date of birth ^*

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If you have any questions or comments, please leave them below!

Or email us at [email protected]

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Thank you for your interest!

Seeing that we are the right practice for you, we will reach out
via email to schedule an intake phone call!

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