Client Support Services Intake Form
If you have applied, been approved and already have a login - please do NOT use this form you can access and update your details here
You have been directed here by a Consultant or trusted friend – Welcome.
Please complete the below questionnaire to help determine the most appropriate protocol for you. This is an essential requirement for an initial consultation to assist in providing the correct on-going support for your health and wellness goals. This form does not have a "save" function so please ensure you have at least 10 minutes to complete the form in one sitting, or have essential information handy elsewhere on your computer for you to copy and paste as needed.
At the completion of the form please click the "I am not a robot" box. Once you have clicked this box and the "Submit" button, your form will be sent to your preferred Consultant. You will receive a welcome email notification that contains important information about your consultation and a link to Frequently Asked Questions (FAQ's) that may be helpful for you and your support team. If you do not have a preferred Consultant or Wellness Clinic, you will be contacted within 48 hours to discuss your individual needs.
Please save the email and password you have selected for your account as this will be your access to on-line product ordering and support resources. Please note that your application will be approved at the time of consultation which will then grant you full access to the site and NOT before.
If you are completing this form on behalf of a child, another person or an animal, please ensure your contact details are noted in the "Carers" section and only complete questions that apply to the relevant persons situation.