Initial Application: HEALx

IMPORTANT HEALx Information

Thank you for choosing HEALx. Our goal is to help you experience true wellness through faith-based, holistic healing. HEALx combines advanced frequency technology with nutritional support to activate the body’s natural ability to heal, restore, and thrive.

Our noninvasive protocol helps raise your body’s energy and cellular function to support focus, immunity, energy, sleep, and overall well-being. We are honored to walk with you on your journey to recharge, regenerate, and heal.

Please complete the questions below to help us determine if HEALx is right for you. All information is confidential.

First name

Last name

Phone

Birthday

Month

Day

Year

Tell us a little about your individual needs, symptoms, or diagnosis, and what has led you to seek support through HEALx Holistic Alternative Therapies.

How did you hear about HEALx and our protocol?

Services

Signature

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We require a 30% non-refundable deposit to secure this HEALx booking, which is collected at the time of package scheduling.

Sign your full name to agree to understanding this requirement.

30% non-refundable Deposit

We start all HEALx packages on Monday. What is your ideal start date (Pick a Monday).

Address

Gender

Height

Current Weight