Schedule Appointment with Temple Glow Wellness

Loading...

First Name *

Last Name *

Phone *

Your E-Mail Address *

Notes to Business (your address or any special notes about your order)

Item	Quantity	Total
MAINTAINING VIBRANCE Membership	x $38.00	$38.00 per month
Total: $38.00	Coupon:

I HAVE READ & AGREE TO THE:

FOR FUNCTIONAL MEDICINE MEMBERS: TERMS & CONSENTS [Please note: Functional Medicine patients, this is the SAME as document signed prior to booking your INITIAL VISIT.]

FOR MORE THAN MACROS PROGRAM MEMBERS: TERMS & CONSENTS

FOR NOURISHED GESTATIONAL DIABETES GROUP MEMBERS: TERMS & CONSENTS

(All members have access to a copy of these documents in the Member's Lounge on the website)

By signing you agree that:

• You have had opportunities to ask questions and have had them answered to your satisfaction.

• You have read and fully understand the TERMS & CONSENTS and have all of the knowledge you currently desire.

• You are a resident of Florida, legally competent, and have sufficient knowledge to give voluntary and informed consent.