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.
Email address *
First & Last Name *
Your answer
What is your Facebook user Name? We will send you an invite at the beginning of March to the private Cleanse Group. *
Your answer
Do you know a doTERRA wellness advocate? Please select their name below. *
If you selected "other" above, please specify who:
Your answer
Do you have a cleanse buddy? Friends who register to cleanse together will be entered in our raffle drawing. Please provide their name.
Your answer
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? *
Your answer
Do you have any chronic health conditions, or health concerns that we should be aware of? *
Your answer
Are you currently under the care of a physician? If so, please provide details below: *
Your answer
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. *
Your answer
Is there any thing else you would like us to know?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service