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Colorful Leaves

NATUROPATHY

Empowering Health Naturally
  1. Fill out all 3 pages as best you can.

  2. Please note that using the back button on your browser may result in the loss of all filled forms. Instead, you can add any information on the last page.

  3. On the last page (page 3), click 'Submit' and proceed to payment via PayPal.

  4. The naturopath may contact you to request any additional information.

  5. Please allow 1-5 business days for your personalized recommendations to be sent to you from our certified Naturopath.

  6. Receive your report and receipt for your insurance via the email you provided.

Visacova Santé

Naturopathic Health Intake Form

Gender
Birthday

Please ensure to click "Submit" at the end of each form page. After submitting, click "Next" to proceed to the following page in the questionnaire. Payment will be processed on the last page of the form.

Reminder: Click "Submit" before clicking "Next".

Explore our other treatments at Visacova Santé, including massotherapy and flexiotherapy.

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