Skin Health Labs

Skin Health Labs

This offering is made possible through Well Wellness Naturopathic Care by Dr. Brianna England. https://wellwellnesshealth.com
We believe access to foundational health insight should be available to everyone. Your skin health is a reflection of your internal function. 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.
Participant Information
Name*

First NameLast Name
Date of Birth *

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Do you consent to receive SMS messaging?

YesNo
Biological Sex*
City/State you Reside *
How did you hear about B-Unique Beauty?
Wellness Snapshot
What are your top 1-3 health concerns right now?
Type a question*

Fatigue/Low EnergyBrain FogHair Thinning or LossDry, Itchy, or Acne-Prone SkinBloating or Digestive IssuesAnxiety or DepressionPainful or Irregular PeriodsPremenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)Spotting Between CyclesMood swings or IrritabilityDiffculty Losing Weight or Gaining WeightLow LibidoPregnancyPostpartumFertility ConcernsPerimenopause/MenopauseCardiovascular ConcernsPre-Diabetes/Type 2 DiabetesAcneEczemaHyperpigmentation (Dark Spots)Melasma
Other (Fill free to expound on any of the above checked):
Have you had lab work done in the past 6-12 months

YesNoNot sure
Do you have Health Insurance and/or a Primary Care Provider
Consent
This is a wellness service. Lab fees vary and are paid separately. If you are looking to order a skin health lab individually from any of B-Unique Beauty Programs (labs included...Do you acknowledge and accept that you will be responsible for paying the lab(s)+ Lab/Consult Fee OR lab(s) +Lab Access fee w/No Consult Fee and an invoice bill will be sent prior to ordering the lab(s)?

YesNot yet, I just want more information about the various labs available
Once your form is reviewed, you'll receive an email and phone call with instructions to: 1. Set up your Fullscript account (where your labs will be ordered), 2. If requesting lab work outside of any B-Unique Beauty programs; you will receive a call from Kayla to review your registration form and choose the appropriate skin health lab. Do you acknowledge and accept this?*

Yes
B-Unique Beauty works with Dr. Brianna's Wellness Workup partnered program, do you consent to Dr. Brianna sharing your lab results with me? If you select "No," results will not be shared and may impact my (Kayla) ability to provide optimized targeted care for your skin health journey. By selecting "Yes," you consent to Dr. Brianna sharing your lab results with Kayla Boddy.

YesNo
Any additional comments or information you would like to share?
Signature*
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Skin Health Labs

Participant Information

Wellness Snapshot

Consent