10-Day Online Detox Registration
I am so thrilled for you that you have decided to participate in the 10-Day Detox! Over the last 7 years, I've been part of a team conducting group detox programs and love to hear about the great results that participants have gotten. Now it's your turn. Please complete this registration form to enroll. Once your enrollment form is complete, I will be sending you a welcome email along with an invoice that can be paid online or with a check by mail. Please be sure to complete your registration no later than Friday, October 25th. Payment in full is required to participate.
If you are new to the detox, please know that the 30-minute consultation is a required component of your program. If you have completed the detox, you may use that time to reconnect if you have new concerns or would like a quick check-in prior to starting. If you are new or are electing to complete either the 30-minute consultation or have body composition testing completed, I will send you a link to my online scheduling platform to arrange a time for those appointments.
Name (First and Last)
Address (Street, City, State, Zip)
Date of Birth
Is this your first time completing a detox with Insights Wellness or True Health?
Please indicate which components of the detox you'd like to add to your experience.
30-Minute Check-In** Required for any new clients...$30
Clear Change Detox Kit including UC Renew, AdvaClear, and a Blender Bottle...$120
Ultra Clear Renew (without the kit)...$85
Body Composition Testing - single session...$25
Body Composition Testing - two sessions (before/after)...$50
I would like to access the information but not add any additional enhancements at this time. ** New clients must still complete the 30-minute check-in.
What flavor Ultra Clear would you like to order?
Please share the results that you would be the most pleased in obtaining in the space below.
Please indicate any health concerns that you have that you feel may interfere with your ability to safely participate.
Please list any medications or supplements that you are currently taking along with their dose.
By electronically signing below, you are indicating your awareness that participating in this detox may increase your fertility or likelihood of getting pregnant. It may also impact the efficacy of oral birth control. Back up barrier methods are recommended.
In the space below, please share any additional information that you would like for me to know.
Please email me an invoice and I will send in a check for payment (due October 25th)
Please email me an invoice with online billing options, $5 convenience fee applies (due October 25th)
INSIGHTS Wellness Company LLC Release from Liability (Name & Date below, please)
For Educational and Informational Purposes Only. The information contained in the wellness workshops is for educational and informational purposes only, and is made available to you as self-help tools for your own use. You acknowledge that I am supporting you in my role exclusively as a health coach. I provide information concerning, but not limited to, the maximizing of human health and optimizing wellness. The information contained in the workshops is not intended to be a substitute for professional medical advice, diagnosis or treatment that can be provided by your physician, therapist, licensed dietitian or nutritionist, or any other health care professional. I am not a medical health practitioner or mental health provider and I do not holding myself out to be in any capacity. I am not providing health care, medical or nutrition therapy services or attempting to diagnose, treat or cure in any manner whatsoever any disease, condition or other physical or mental ailment of the human body. Rather, I serve as a coach, mentor and guide to help you reach your own health and wellness goals through implementing incremental, positive, healthy, sustainable lifestyle changes that help you live and thrive using simple methods. Please consult your physician or health care provider. My intent is NOT to replace any relationship that exists, or should exist, between you and a medical doctor or other health care professional. Always seek the advice of your physician or another qualified healthcare professional regarding any questions or concerns you have about your specific health situation, possible or actual pregnancy, known or suspected food sensitivities or allergies, dietary restrictions, or any medications you are currently taking. It is advised that you to speak with your own physician before implementing any suggestions from the wellness workshops before taking any medication, herbal, ayurvedic or homeopathic supplement; engaging in an elimination diet, detox or cleanse; performing deep breathing exercises; or participating in any other aspect of a food, diet, exercise or lifestyle program. Do not disregard professional medical advice or delay seeking professional advice because of information you have received from me. Do not stop taking any medications without speaking to your physician or health care professional. If you have or suspect that you have a medical problem, contact your health care provider promptly. By electronically signing below, you acknowledge that you release Insights Wellness Company LLC from claims for any loss or damages.
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