Family Wellness Membership Application

Family Wellness Membership Application

We will email you if your application is accepted and provide you with next steps, thank you for being here! Keep an eye on your email.
Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Facebook Profile link (or your full Facebook name):

How many family members living in your home, including children and pets? Please list their ages and indicate what type of pet (example: 3 members, child 12, dog 3, adult 49)
What are you looking for in this membership? What would tell you that this membership has been valuable to you?
What is your current TCM experience? What is your current holistic healthcare experience outside of TCM?

Are you primarily responsible for taking care of your family's healthcare needs?
What is your family healthcare wishlist- dream big, what do you hope this membership can help you with that will make your life easier, and your mind rest easier in regards to your families health?

This membership is about teaching you to navigate the common health issues that come up in your household through holistic means. This is as much about me answering your questions to solve acute health issues as they arise as it is teaching you the TCM principles that can be both preventative and treatment oriented for you in the future. This program gives you the understanding and personalized tools you need to feel confident handling the symptoms that show up in your household, as well as the framework to know when you need seek medical intervention. Please know that this is neither an insurance product nor a replacement for medical care.
Have you worked with Hayley Gardner MSOM DCCM LAc for Chinese Medicine care before?