First Name *

Last Name *

Phone *

D.O.B *

Email *

Gender *

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Female

Program Fee *

$ 1400

By checking this box, I acknowledge that the health coaching services provided by Drip Into Wellness are intended to support and guide my wellness journey. I understand that these services are not a substitute for medical care provided by a licensed physician.

I recognize and agree to the following:

No Medical Diagnosis or Treatment: Drip Into Wellness does not diagnose, treat, cure, or prevent any disease or medical condition.
Consultation with Primary Care Physician: Before starting any new supplement regimen, IV therapy, or vitamin injection protocol, I should consult with my primary care physician or healthcare provider.
Personal Responsibility: I understand that my success depends on my commitment to following the personalized health plan developed in collaboration with my health coach.

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.

I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

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By signing this consent form, I confirm that I have read, understood, and agree to the terms outlined above.