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Forms

Click to Download

All client information are held confidential, according to HIPAA Privacy Rule, State Laws and Regulation.

Informed Consent Form

Please read carefully before signing

Health Assessment Form

Basic Information- must be completed by all clients regarding Health History

Eating Habits

 Nutritional Support

Whole LifeWellness Challenge

Submit a One time payment of $55.00 via PayPal.me/Prolifichw or CashApp $Prolifichw, along with EMAIL attached!

 Then you will receive online access to 6 Week ''Whole Life" Wellness Challenge 

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