Cleanse, Restore, Renew Registration Form
Welcome, we are so excited that you will be joining us for this cleanse! Fill out the form below to get started.
First & Last Name
What is your Facebook user Name? We will send you an invite at the beginning of March to the private Cleanse Group.
Do you know a doTERRA wellness advocate? Please select their name below.
Mookshi Wellness Center
If you selected "other" above, please specify who:
Do you have a cleanse buddy? Friends who register to cleanse together will be entered in our raffle drawing. Please provide their name.
Is this your first time doing a cleanse?
Tell us a little bit about why you are choosing to cleanse. What are your health goals and priorities? What are you hoping to get out of your cleanse experience?
Do you have any chronic health conditions, or health concerns that we should be aware of?
Are you currently under the care of a physician? If so, please provide details below:
The facilitators do not assume responsibility for the individual results of your cleanse experience. You are advised to consult your doctor prior to being the cleanse if you have specifics concerns. Please type your name below to acknowledge that by participating in this cleanse you are assuming responsibility for your health & well-being.
Is there any thing else you would like us to know?
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