Well of Life Center for Holistic Healthcare

Welcome to The Well of Life

Thank you for scheduling your appointment!

Thank you for scheduling your appointment. Please complete and submit this form at least 48 hours prior to your initial nutritional consultion. For any other appointment types, new client paperwork will be emailed to you. Please understand the importance of keeping your appointments. We do have a 48 hour new client/24 hour regular client appointment cancellation policy that is strictly enforced.

This form should not be completed until after you schedule your initial appointment with our Client Advocate Team. Please schedule an appointment here prior to filling out this form.

PLEASE NOTE: This form is for clients 18 and older. For children under 18 please use this form.

Personal Health and Lifestyle

Family Health History


Please check if any of the following conditions currently apply to you:

By checking above, you are indicating that you have read and understand that you cannot be seen for your Initial Consultation unless the following requirements are met:
(1) this New Client Form must be completed and submitted; (2) the Nutritional Questionnaire (separate from this form) must be completed; (3) your current medications and supplements must be brought to your Initial Consultation.
Please click HERE to read our Agreement and Release of Liability. Then, sign by typing your full name in the box above. By signing, you are acknowledging that you have read and accept the terms and conditions of the disclaimer.

Thank you. Have a nice day!

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