The Wellness Workup Initiative Registration Form

The Wellness Workup

This offering is made possible through Well Wellness Naturopathic Care as a Community Service Initiative. https://wellwellnesshealth.com
You can request labs that matter to you, whether you're searching for peace of mind, preparing to advocate for yourself, simply curious about where you stand with your labs, or starting your healing journey.

Dr. Brie believes that access to foundational health insight should be available to everyone. This is more than a test. It's your baseline for your testimony. This is an opportunity to gain insight into what's really going on inside your body without needing a referral or relying on insurance. When you know what's happening in your body, you can become aligned for complete wellbeing.

Your labs are yours to:

Keep for your own awareness
Review with your doctor
Or take the next step and work with me through

Access Fee: $45
Access to over 7,000 labs (pay for labs at discounted rate)

If you would like the option for Dr. Brie to reivew your lab results with you, there is an additonal $150 consultation fee that will be applied to your lab order
Participant Information
Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Date of Birth

MonthDayYear
Date
Biological Sex
City,State you Reside in
How did you hear about The Wellness Workup Initiative? Please name the organization or provider who referred you. If through social media, just note that.
Wellness Snapshot
What are your top 1-3 health concerns right now?
What symptoms are you currently experiencing? (Check all that apply)

Other
Have you had lab work done in the past 6-12 months
Do you have Health Insurance and/or a Primary Care Provider?
What would you like to do with your lab results?
Would you like support in choosing which labs to order based on your symptoms?
If you are apart of a Wellness Workup program with a partnered provider/practitioner, please provide the program you are apart of and the name of the practitioner. If this doesn't apply, note "NA"
Consent
This is a community service wellness service. Lab fees vary and are paid separately. The $45 registration covers access to over 7,000 labs + administrative fees. Do you acknowledge and accept this?
Once your form is reviewed, you'll receive an email with instructions to: 1. Set up your Fullscript account (where your labs will be ordered), 2. Receive a call from Dr. Brie reviewing your registration form, 3. Receive your lab order, and Submit payment for labs + $45 Registration fee. If you'd like more clarity on which labs to oder, Dr. Brie can go over recommendations during your call with her. Do you acknowledge and accept this?
If you are apart of a Wellness Workup partnered program, do you consent to Dr. Brie sharing your lab results with your program practitioner. By selections no, no results will be shared and may impact your practitioner’s ability to provide optimized targeted care. By selecting yes, you consent to Dr. Brie sharing your lab results and acknowledge Dr. Brie will provide educational insight to yourself and/or your practitioner. If you are not apart of a partnered program, please note "NA".
If you are using a discount code, please provide it here.
Any additional comments or information you would like to share?
Signature
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The Wellness Workup

Your labs are yours to:

Participant Information

Wellness Snapshot

Consent