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Detox Registration
Detox Registration
Please answer the following questions to register for my Detox Program.
Detox Registration
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    • Email
    • Text
    • Phone
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    • Beginner's (14 days)
    • Intermediate (14 days)
    • Advanced (21 days)
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    This information is required to be sure there are no contraindications with any of the herbs and supplements recommended during the detox.
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    Please be sure they are relevant to the service or program you have registered for.
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    Wellness Program Terms & Conditions (please read)

    • All information provided in this form and going forward is confidential and will not be released to anyone. 
    • Information provided during the program does not take into account all individual conditions and may therefore not be advisable or beneficial to all participants.
    • Dana Clark/From the Roots Holistic is not liable for misuse, misunderstanding, injury or health issues that may ensue from the information provided during the program.
    • Information provided by Dana is in accordance with her formal academic training, continued education, and science-based research.
    • For Health Benefit Claims, you are encouraged to inquire and confirm that you are covered for my services (Registered Nutritional Consultant and/or Certified Natural Health Practitioner) and to submit receipts to your insurance company.
    • All fees are non refundable.
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