215-340-3930

Well of Life Center for Holistic Healthcare

215-340-3930

Welcome to the Well!

Thank you for scheduling your appointment. Please submit this form at least 24 hours prior to your Initial Nutritional Consultation.

This form should not be completed prior to scheduling your initial appointment with our Client Advocate Team. Please schedule an appointment prior to filling out this form.

Personal Health and Lifestyle

Family Health History

THIS SECTION IS FOR WOMEN ONLY

Please check if any of the following conditions currently apply to you:

By checking above, you are indicating that you have read and understand that you cannot be seen for your Initial Consultation unless the following requirements are met:
(1) this New Client Form must be completed and submitted; (2) the Nutritional Questionnaire (separate from this form) must be completed; (3) your current medications and supplements must be brought to your Initial Consultation.
Please click here to read our Agreement and Release of Liability. Then, sign by typing your full name in the box above. By signing, you are acknowledging that you have read and accept the terms and conditions of the disclaimer.

Thank you. Have a nice day!

Our Wellness Services

Please click on one of the below links for more information about each type of modality we offer.

CHEMICAL PEELS

A chemical peel is a technique which involves the application of a variety of chemical solutions to remove the damaged outer layers of dead skin cells from the skin’s surface.

FACIAL REJUVENATION ACUPUNCTURE

Facial Rejuvenation Acupuncture may be used to nourish, rehydrate, and tone your skin, while reducing the appearance of facial wrinkles and improving the skin’s elasticity.

MICRODERMABRASION

Microdermabrasion removes dead and flaking skin and stimulates the production of young skin cells and collagen.

INFRARED SAUNA

Our infrared sauna creates a blend of wavelengths that have been shown to lower blood pressure, increase core temperature, aid in weight loss, and so much more!

IONCLEANSE FOOTBATH

This relaxing, therapeutic foot bath helps detoxify the body at a cellular level and restore balance to all of the body’s systems.

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