Be Naturally Well PMA

Biofeedback and Wellness Services

BE NATURALLY WELL INTAKE FORM AND AGREEMENT

Intake
0% Complete
1 of 11

Thank you for your interest in working with Be Naturally Well Ministries. I'm focused on providing you the highest level of support and privacy.

Email all your health reports/ test results to: benaturallywell@protonmail.com
Phone: (949) 697-3152

Scheduling of consultations are done after I have received your intake form and have had a chance to review your history and situation. Please provide a thorough history and all pertinent results for your home and body prior to our consultation.

Reply and correspondence emails will be returned in 2-3 business days. Please keep emails to a minimum between appointments, and please be direct and state the issue in the subject of the email. Emails formatted with questions are best, so I can respond directly to the questions. When the issue is more complex, we may need to schedule a short consult/call so I have the proper context to evaluate.

Member Fees and Services

  • Initial Consultation $350
  • Follow up Consultations $175 per clinical hour (50 minutes)

Payments are invoiced through PayPal and will be billed following the consult. Please send payment via check or using Zelle when possible. Please allow a 48-hour cancellation notice to avoid being billed.

Records and Health Journal: I highly recommend keeping a record of all labs and test reports in a home file. Whenever you have a test or lab done, please obtain a copy for your home file. In addition, I recommend keeping a health notebook or journal to chronicle and keep notes in to track symptoms, supplements, dietary changes, etc.

Disclaimer: All services and information provided by Be Naturally Well are not intended to be a substitute for medical advice, diagnosis or treatment by your in-network health provider. Please discuss with your primary provider as needed. I am happy to collaborate and discuss with your primary provider on any issue that you provide consent. Many doctors are not familiar with Environmental/Biotoxin illness and/or Functional Medicine. Achieving the highest level of health naturally is my mission, and I am dedicated to educating and empowering you to achieve the highest level of health through addressing the 3 pillars of health: Home, Body, Mindset. By submitting this form, you agree to abide by all the Terms and Conditions.

Street Address
Street Address
City
State/Province
Zip/Postal
Country
Time of Birth
Optional