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Welcome Back

It is so nice to see you again. You have made a great decision when you chose to go nature's way. I trust that your first, and any other sessions that you have had was a positive experience. While you are here, please give us a little information as to why you chose to return and continue with your treatment plan. Please fill out the form below. this information is important to us, as we may use it to direct your next treatment plan. We are aware that the journey ahead can be difficult, and we do not want you to feel as it you are alone. Here at Tree of Life - My [W]Holistic journey, we are taking the responsibility to send you at least two words of affirmation to your email or phone number twice per week as a way to keep you energized and continue your holistic journey until you see the result you desire.

That by selecting the "yes" below, I am attesting to the fact that I am 18 years of age, and that I am of sound mind and can make life changing decisions on my own. Any information and or recommendation I accept[ed] from Tree Of Life, it it to the best of my knowledge based off the information I provided to them at the time of interview. If it is later discovered that at the time that I accepted a recommendation from Tree of Life that may or could have result in an ill-reaction as a direct result of herbs consumed or could have consumed, AND that I lacked capacity to do so, I, my guardian, family and or representatives agree to hold harmless Tree of Life from any lawsuit that could arise from a negative reaction to the herbs I consumed. Tree of Life will take the necessary steps to ensure that care is taken when making a recommendation or providing coaching. *

I am of age and of sound mind

I hold harmless Tree of Life for any information I have withheld.

Enter your full legal name here*

Enter your email address here*

Enter your phone number

Are you on any herbal treatment plan, or pharmaceutical medications, If yes, list the herbs/medication in the space provided*

Do you have any known allergic reactions to herbs.*

If you answer yes to having an allergic reaction to herb(s) Share your reactions with us.*

I am aware that by selecting the button below, I consent to being fully cognizant of the DISCLAIMER statement, and that I give consent to Tree of life and its representative(s), if any to recommend herbs, counselling in the interest of my well-being.*

By selcting this button, I give consent to Tree of Life

DISCLAIMER*

Are you sure you wish to proceed, because you are aware of ALL the information on this form?*

yes

No (if you answer 'no' we will not reach out to you, as Tree of Life DOES NOT SOLICIT.

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