Name
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First Name
Last Name
Email
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Subject
Phone
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(###)
###
####
How did you find us?
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Web Search
Facebook
Instagram
Pinterest
Personal Referral
Other
If "Personal Referral" (What's their name?) or "Other" please explain.
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Do you seek to raise your level of health due to a specific condition?
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Yes
No
If "yes", what is it, and how long have you been dealing with this?
Do you seek to simply maintain your current level of health?
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Yes
No
Do you seek to be proactive and focus on prevention?
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Yes
No
What services do you seek?
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Bodywork / CranioSacral Therapy
Customized Nutrient Support
Methylation & Genetic Support
Post-Concussion / Brain Injury Support
Clinical Detox
Quantum Biofeedback
Strategic Intervention Coaching
Medical Intuition
Stone Listening
Other
If "other", please explain.
How soon would you like to be contacted?
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ASAP it's urgent
Within 7 days
Best time to reach you?
*
How should we contact you?
*
Email
Phone
Disclaimer
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Designed for Thriving is intentionally a Private Membership Association (PMA). Our trained professionals are not doctors, and we do not diagnose or prescribe. We work with the innate intelligence and design of the body, to identify and provide access to the resources and resonance that your body needs to heal itself whenever possible. We believe there is a time and a place for all methods of medicine. As a member of our private association, your constitutional right to health care freedom and privacy is preserved while we are able to provide you safe and effective products and services with fewer restrictions. Our work is based on the bioenergetic optimization. We use sustainable, integrative, intelligent and effective methods including conscious choices to really serve you and improve your life.
The information obtained during Designed for Thriving (PMA) seminars, lectures, talks, demonstrations, energy work sessions, complimentary consults, email or verbal conversation, and any of the supporting information provided by Designed for Thriving as to its services and benefits to its private members, is for educational purposes only. Although we have extensive training and clinical research regarding the principles of Combination Homeopathy, Quantum Nutrition, Botanical Medicine, Ionic Therapies, Quantum Biofeedback (QBF), Health Kinesiology (HK), Massage Therapy, CranioSacral Therapy, Quantum Reflex Analysis (QRA), Morphogenic Field Technique (MFT), RadioKinesis, BioEnergetic Medicine, Neuro Cranial Integration (NCi), Colon Hydrotherapy, and Strategic Intervention Coaching, our trustees, officers and supporting staff of Designed for Thriving, are not licensed healthcare or medical providers. Information provided by members of Designed for Thriving should not be considered a substitute for the advice of or diagnosis by a licensed healthcare or medical practitioner in handling your medical needs.
I have read and understand the disclaimer above.