Wellness Package Plan


Please fill out the form below to sign up for the Wellness Package Plan. I will contact you to schedule an introductory meeting and send you sign up forms before Sign up is complete. Sign-up is complete when we have spoken together and signed the necessary forms. I will process your payment on the date choosen in accordance with our agreement. 

Name *
Address *
$125 monthly starting on the 1st of next month, $100 for the first month if paid at sign up.
Phone *
Card number
Expiration Date *
Expiration Date