Allmond Wellness 37

New Client Registration

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Welcome to Allmond Wellness! We are a health coaching practice focused on assisting client’s in evaluating their diet, lifestyle, genetics, toxin exposure, levels of inflammation, gut health, and chemical imbalance. Removing impediments in these areas will always lead to improved brain health and longevity. Are you ready to make changes? Come join us on what will be an enlightening and exciting journey to wellness!

NEW CLIENT REGISTRATION FORM

***Allmond Wellness protects your privacy with a 100% guarantee! Your information will not be shared with ANYONE unless you endorse it by filing an official Release of Information Form with our office***

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CLIENT INFORMATION
Name*
MM slash DD slash YYYY
Full Home Address
CURRENT HEALTH CARE TEAM
EMERGENCY CONTACT INFORMATION
FEES & SERVICES

Allmond Wellness is a fee-for-service practice. We do not accept insurance but, are always happy to supply a “superbill” with coding that can be submitted to your insurance company for potential reimbursement.

Initial New Client Evaluation-this includes a 90 minute evaluation appointment, review of submitted pertinent past records, ordering of phase one lab testing and treatment planning. There is extensive time spent outside of the 90 minute evaluation-$400

60 Minute Follow Up Appointments-$250

30 Minute Follow Up Appointments-$125

OFFICE HOURS

By appointment only

LATE FEES AND CANCELLATIONS Once an appointment is scheduled, it is expected that you will keep the appointment and pay for it at the time of service. Should you need to cancel or reschedule said appointment, it is kindly requested that you do so at least 24 hours in advance. Violations of this cancellation policy will lead to a $50 fee.

THANK YOU!

Thank you for your interest in Allmond Wellness! We are excited to help you get started on your road to healing and wellness. By signing below, you attest that you have read the information and agree with stated policies. Your paperwork will be reviewed in the order in which it was received, and you will be contacted to schedule your intake appointment as soon as possible. In the meantime, direct any questions you may have to: Allmondwellness37@gmail.com.

Consent*