Clinic Partner Application Form

This short form helps us understand your clinic’s readiness for integration. Every application is reviewed with care by our team.

Clinic Name *

Email *

Phone *

Full Name *

I agree to the terms & conditions provided by Spark Life Consulting. I agree to receive text messages from this business.

What is your Clinics Website *

Years in Operation *

Do you currently offer weight loss services? *

Yes

No

State *

What's Your Monthly Revenue? *

<$10k
$10,000-$25,000
$25,000-$50,000
$50,000-$100,000+
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Do you have at least 25 public reviews on Google with a 4.0+ average rating? *

Yes

No

Are you willing to participate in required trainings, maintain compliance, and uphold clinical integrity as defined by Rewaken Life®’s standards? *

Yes, absolutely

Unsure, I have questions

No

How soon are you hoping to integrate medical weightloss? *

Within 2 weeks

Within 30 days

Just exploring

Is there anything else we should know as we consider your application?

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