Health & Wellness Enrollment Form
If you're ready to take control of your health, our goal here at Better Than Blessed Health & Wellness is to renew your mind, body, and soul without the need for medications. We have an amazing plan that is not only affordable, but will help you live better than blessed! For a small monthly investment for a minumum of 6 months, we will help you begin your journey to health & wealth! Let's get started!!!
Email address *
Name *
Phone # *
Mailing Address *
What is Your Main Health Concern? *
Do you want to be medication free? *
Are you willing to invest monthly to achieve your health goals? *
Can you commit to the program for 6 months? *
Choose from 1 or 2 of the following sample packs to get started. Each monthly shipment will be a 2 weeks supply of whatever option you select. *
Please enter credit/debit card number, expiration date, 3 digit security code, and billing zip code on the line below that will be charged today and every 30 days for your order based on which option you choose. *
If you prefer not to input credit card information here, you can pay by clicking here to complete initial payment *
The item selected above will be shipped to you every month for the next 6 months unless you call us to change your selection. There will be a $15 administrative fee to make changes. *
By checking the box below, I agree to an initial charge from Better Than Blessed Enterprises and a recurring charge monthly to the credit/debit card listed above to be charged on the same date each month. If I close my card or discontinue program before the end of 6 months, I will be prohibited from utilizing the program in the future. I can only cancel after being in the program for 6 consecutive months. *
If you have further questions, feel free to contact us at 800-736-0854 ext 803 Monday-Friday 9:30am-5:30pm EST or make direct purchases on our website at
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy