BODY MAX HARMONICS Practitioner Membership Application
  • BODY MAX HARMONICS Practitioner Membership Application

  • IMPORTANT— PLEASE READ BEFORE COMPLETING THIS FORM:

    Body MAX Harmonics is a wellness education platform operated by an unlicensed alternative health and wellness practitioner. Membership is open to health and wellness practitioners regardless of licensure status —licensed, certified, and non-licensed practitioners are all welcome. All members, regardless of credential status, are solely responsible for all decisions made in connection with their use of program materials, and must accurately represent their own qualifications to their clients at all times. A full Practitioner Acknowledgment & Responsibility Agreement will be provided for signature before membership is activated.
  • Format: (000) 000-0000.
  • Professional Credentials & Background

  • The following fields apply to Licensed and Certified Practitioners only. Non-licensed practitioners may skip to Professional Certifications below.

  •  - -
  • Licensed / certified practitioners: Is your credential currently in good standing with no pending investigations, suspensions, or disciplinary actions? (N/A if non-licensed)
  • Do you carry active professional liability or wellness practitioner insurance?
  • Practice Information

  • Practice Setting (select all that apply)*
  • Primary Clinical or Wellness Focus Areas*
  • Education & Continuing Education Background

  • Have you completed any training in the following areas? (select all that apply)
  • Program Fit Questionnaire

    The following questions help us understand how Body MAX Harmonics can best support your practice and ensure the program is the right fit for you. Please answer thoughtfully —there are no right or wrong answers.
  • How did you hear about Body MAX Harmonics?
  • Which of the following best describes your familiarity with the gut-brain axis and precision neurological wellness?
  • Which of the following topics are you most interested in developing further through this membership?
  • How many hours per week are you typically able to dedicate to professional development and continuing education?
  • Are you currently using any protocols or frameworks from other precision health, functional medicine, or longevity education platforms?
  • Do you currently use FullScript to dispense supplements to clients?
  • If no — are you interested in setting up a FullScript account as part of your membership?
  • Have you worked with clients who have neurological conditions, neuromotor presentations, or neuroinflammatory concerns?
  • Membership Tier Interest

    Review the three membership options below and indicate your initial interest. Your final tier selection will be confirmed during the alignment call based on your scope of practice and goals. There is no obligation at this stage.
  • All memberships require a 3 month commitment MINIMUM

    ESSENTIAL - $300 / month

    + Full protocol library

    + Community forum

    + Recorded weekly calls

    + Certification (audit)

     

    FOUNDATION - $500 / month

    + Everything in Essential

    + Live weekly calls

    + 3 support requests/month

    + Certification enrolled at discount

     

    APEX - $800 / month

    + Everything in Foundation

    + 3support requests/month

    + Mentorship track

    + Early protocol access

    +Certification Program

  • Final tier selection is made during your alignment call. Annual billing options with (10-15% savings) are available and will be discussed during onboarding.

  • Acknowledgments & Declarations

    Please read each statement carefully and check to confirm your understanding.
  • Acknowledgments & Declarations*
  • Signature & Date

    By signing below, I confirm that I have read, understood, and agree to all statements in Section 7, and that all information provided in this application is accurate and complete.
  •  - -
  • Should be Empty: