Thrivability Eligibility

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Thrivability™ is a registered 501(c)(3) wellness charity offering nutrient-rich intramuscular (IM) injections (B12 shots + others) on a sliding scale to those who are eligible. We offer all-natural shots formulated with vitamins, minerals, antioxidants, amino acids + homeopathic medicines for wellness, prevention of illness + to facilitate healing for both acute + chronic conditions. We believe everyone deserves access to this wonderful service + that nothing should be a barrier to experiencing the healing power of this treatment modality. We want everyone to be healthy, physically + mentally, and to thrive! That is our core mission. We're proud to serve first responders, devout vegans, medically disabled, those faced with financial hardship + primary caregivers who care for a family member with a severe medical disability.

Please take a few moments to complete this short eligibility form.
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Name* This field is required
First Name
Last Name
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Please choose one of the following reasons why you are seeking status as a client with Thrivability™ for nutrient injection therapy.* This field is required
LOW INCOME (unemployed, fixed income)
SEVERE MEDICAL DISABILITY
FIRST RESPONDER (police officer, firefighter, active military, veteran)
DEVOUT VEGAN (those who don't eat or use animal products including honey, milk, eggs, wool, leather, etc.)
PRIMARY CAREGIVER of a family member with a severe medical disability
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Please select one of the following to explain your low income status.* This field is required
Unemployed
Disabled
Fixed Income
Other
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Please explain your answer "other."* This field is required
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What is your diagnosis.* This field is required
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What is your family member's diagnosis? How are you related?* This field is requiredYou must be the primary caregiver of a family member who is medically disabled.
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Please select one of the following.* This field is requiredPlease present your badge or ID for verification.
Police Officer
Firefighter
Active Military
Veteran
Paramedic
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Please state your annual household income*.* This field is required
*Annual Household Income is the combined earnings for one year of all adults sharing a residence.
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How many people are in your household?* This field is requiredInclude all adults and children living at your place of residence.
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Contact InformationPlease provide us with your email address so we may contact you should we need to clarify anything with your enrollment or eligibility.
example@example.com
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You agree that all your answers are true to the best of your knowledge. If you're approved for the THRIVABILITY program, you'll need to complete and e-sign a separate Consent Form prior to receiving treatment if you have not done so already.* This field is requiredPlease sign and click submit.
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