Wellness Center & Organic Cafe

Please fill out these forms in advance of your appointment to save time.  We separate the different forms that we need based on the service your are signed up for.  Please fill out all appropriate forms.  If anything changes, please update your forms before coming in.  Thanks so much!

​

***Basic Demographic Intake

Everyone must fill out this form before the first appointment.  Please also see below any other forms you may need to fill out.

​

Consultation Form

This form should be filled out for Wellness and Medical Consults. This form is also used for initial screening for those who are unsure where to begin with our services.

​

True Cellular Detox Qualification Form

If you are interested in doing a deep dive cellular detox program, fill out this form.

​

Detox Services Form (Foot Bath, Sauna)

Colon Hydrotherapy Form

Detox Contraindications/Cautions List

These forms should be filled out for ionic foot bath, infrared sauna and colon hydrotherapy.  Also, please read the contraindications list in advance of the appointment.

​

Pulse PEMF Form

This form should be filled out for Pulse PEMF sessions.

​

Body Work Form

This form should be filled out for massage, reflexology, shiatsu or craniosacral.

​

Facial Form

This form should be filled out for all facials

 

Biolight Laser Form

 

This form should be filled out for Biolight low level light therapy

​

Friend Referral Coupons

Print out this form and refer friends to earn money towards your services provided by Nourishing Journey staff