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Membership Application — Electro-Lymphatic Drainage & Wellness
This membership is built for clients who are consistent, engaged, and ready to follow a program. It's not a quick fix — it's personalized, one-on-one care. Takes about 2 minutes. Approved applicants receive next steps within 24 hours.
Section 1 — Contact
Full name
*
Email
*
Phone
*
How did you hear about us?
*
Section 2 — About You
Which best describes you?
*
A
Retired or semi-retired
B
Working profession
C
Student or early career
D
Other
How do you prefer to be contacted?
*
A
Phone call
B
Text
C
Email
How consistent are you with routines you start?
*
A
Very — I finish what I start
B
Somewhat
C
I struggle to stay consistent
How serious are you about reducing your inflammation?
*
A
Very serious — it's a priority
B
Curious, just exploring
C
Not sure yet
What is your #1 wellness goal right now?
*
Are you looking to reduce swelling and inflammation?
*
A
Yes
B
Somewhat
C
Not sure
How ready are you to start?
*
A
Ready now
B
Within 30 days
C
Just exploring
Section 4 — Experience
What have you already tried for your inflammation, and what made you stop?
*
Are you looking for a quick fix, or a program you build over time?
*
A
Quick fix
B
Something I build over time
Have you done a paid membership program before?
*
A
Yes
B
No
Section 5 — Commitment
Are you able to commit to sessions every 3–7 days?
*
A
Yes
B
No
Are you willing to answer questions and follow direction between sessions?
*
A
Yes
B
No
Are you able to pay the $100 membership fee (grants access to purchase packages) plus $375 for your first 3-session package — $475 total — before your appointment?
*
A
Yes
B
No
Are you willing to sign a membership agreement and standard wellness participation waiver before your appointment?
*
A
Yes
B
No
Do you understand lifestyle choices affect your outcomes?
*
A
Yes
B
No
Section 6 — Close
Why do you want
this
program specifically?
*
Anything else we should know?
*
Submit