Global Nutrition – New Client Intake Form

All fields marked required must be completed before your appointment. Incomplete forms may delay or reschedule your visit.

All medications, supplements, doctors, illnesses, and hormone changes MUST be listed.

Client Policies, Consent & Agreement

By submitting this form, I acknowledge and agree to the following:

Programs & Packages

3-Visit Wellness Reset (New Clients)

$449

Perfect for a fresh start or focused support.

Includes:

  • Initial Iridology & Functional Assessment

  • Personalized Nutrition + Herbal/Supplement Plan

  • Two 40-minute follow-up visits

  • Email guidance between visits

Timeframe: Must be completed within 3 months
Best for: Digestive reset, stress support, or clarity on next steps

5-Visit Deep Healing Program (Virtual or In-Office)

$689

A deeper approach to uncover and address root imbalances.

Includes:

  • Full Functional & Iridology Assessment

  • Customized lifestyle, nutrition & supplement plan

  • Four follow-up visits

  • Email support between visits

Timeframe: Must be completed within 5 months
Best for: Chronic issues or ongoing healing

12-Visit Transformational Wellness Program (Virtual or In-Office)

$1,255

A long-term, structured path to full-body transformation.

Includes:

Full Functional & Iridology Assessment

  • 11 follow-up visits over 12 months

  • Gradual detox & rebalancing support

  • Ongoing plan adjustments

  • Priority email & phone support

Timeframe: Must be completed within 12 months
Best for: Long-term healing and full-body reset

Returning Client Programs (Seen within last 12 months)

Boost Visit – $97

  • 40-minute session within 6 months of last visit

  • Plan review + adjustments

  • Iridology progress check

  • Follow-up email support

    Thrive Program – $325

    • Two 45-minute visits within 7–12 months

    • Progress review and plan adjustments

    • Continued support E Mail

Important Policies

  • All appointments and packages are non-transferable

  • One person per visit

  • Packages are used at one visit per month; unused visits are forfeited

  • Boost/Thrive must be used within designated timeframes

  • Email support is for brief clarification only

  • Boost/Thrive email support is limited to 14 days

  • New or ongoing concerns require an appointment

  • 48-hour cancellation notice required or full fee applies

  • No returns on services or supplements