New Client Registration Form

All New Clients are Required to Submit a New Client Registration Form OR Via Secure Email Prior to ANY Holistic & Natural Health Services

The New Client Registration Form allows us to get to know you and your current lifestyle practices prior to your scheduled consultation as well as to analyze the best fit for both client needs/practitioners' program. Please share basic information regarding your health goals. If you would like to send a detailed message please use our secure email contact at lennoxwellness@gmail.com.

A RED Asterisk * Indicates a Required Field & Must Be Answered for the Form to be Completed.

* Indicates required field

Name *

First

Last

Email *

Phone Number *

How Did You Hear About Us? *

referred by? *

What are the most important health questions you would like to talk about at your visit? *

The Lennox Wellness Center of Essential Holistic Refinement™, LLC respects and honors client privacy and does not share client profile information unless authorized by the client. Client profile information submitted is used for the sole purpose of the practitioner to use for any recommendations for the client/practitioner collaboration only.

Please share basic information regarding your health goals. If you would like to send a detailed message please use our secure email contact at lennoxwellness@gmail.com.

Further questions? We are happy to help. Please contact us.

Submit

WELCOME TO
THE LENNOX WELLNESS CENTER