HEALx Application Form

IMPORTANT HEALx Info

This information is used solely for assessing potential candidates for the HEALx bed

All information is, and will remain confidential.

We consider the HEALx med bed to be the most comprehensive blend of frequency technology and nutritional tools available today. Every aspect of what we offer has been prayerfully and purposefully designed with your transformation in mind.

This is where cutting-edge innovation meets the wisdom of holistic wellness.

Our unique protocol is designed to naturally raise your body’s voltage and mitochondrial power to support the healing intelligence God has placed within you. Our protocol allows your mind and body to relax, while your cells recharge at a deep, cellular level without invasive procedures or harmful side effects.

CLICK HERE for HEALx session packages & pricing

A SEPARATE APPLICATION FORM IS NEEDED FOR EACH INDIVIDUAL SEEKING THERAPY

ADDRESS:
Chesaspeake Business Center, 1616 Westgate Circle, Brentwood, TN 37027

Initial Application Form

Type Full Name below in agreement:

First Name

Last Name

Phone Number

Date of Birth

What are your individual needs, symptoms, diagnosis, and why you are seeking support from HEALx holistic alternative therapies:

How did you hear about us and our HEALx Protocol?

Program/Package Requested

HEALx Total Transformation - $6499 (See package details- Requires two (2) sessions per day/5 days per week for intense healing and optimization) HEALx Core Restore (10 pack)- $2299 (See package details) HEALx Boost Recharge (5 pack) - $1299 (See package details) HEALx Single Bed and Vitals Scan - $399 (1 hour with scan and bed session) HEALx Bed Intro Trial - 30 minute Session - $149 Cellular Prep Supplement Package - $289

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

I AGREE

What is your ideal start date?

Street- Mailing Address

State- Mailing Address

ZIP- Mailing Address

Gender

Male Female

Height

Weight

Subtotal	$0.00
Tax	$0.00
Total	$0.00

IMPORTANT HEALx Info

Initial Application Form

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