We want to know a little bit more about you so we know how to serve you best... only takes a few minutes.

Is this application for yourself or your child? *

Myself

Child (under 18)

First Name *

Last Name *

Phone *

Email *

State

Abbreviation please, SC PA NJ

Country

Enter your country

Where are you now...

I'm experiencing serious health issues currently

I am not thriving right now and need help

I am being proactive, wanting to live my best life

Tell us a bit more here... any diagnosis or goals *

(Tell us your health goals — big or small, short symptom list next slide)

Healing takes time and consistency. Our programs require active participation and making necessary lifestyle changes.

Are you able and willing to commit to this?

Yes, I'm ready to do whatever it takes to thrive

Maybe, depending on what's involved

I may need something less intensive right now

Describe how you wish your life could be different 3-6 months from now (optional)

Health Aspirations

Do you understand that Deeper Healing does NOT accept traditional health insurance or medicare?

Yes, I understand it is out of pocket

No, I was hoping they took insurance

We accept CC, HSA, FSA, Care Credit and have financing options available. Some patients with Health Share Plans may qualify for reimbursement depending on their plan. We are here to help you get what you need.

The healing power of Deeper Healing is in-person, in the center. Are you able to come to Deeper Healing Medical Wellness Center in Charleston, SC for testing and care? *

Yes

Maybe

I am unable to travel to begin and would like to schedule a phone or zoom assessment to see if I am a fit

(Note: Deeper Healing helps people from all over the world)

Do you have a contact preference?

Phone call

Text

Open to all

Is there a support person that you would like to include on a discovery call (add name + number)? optional

How did you find Deeper Healing? (optional)

Body Burden Documentary

Physician Referral

Google Search

Medical Support Group

ChatGPT

Dr. Sherri Tenpenny

Dr. Casey Means

Nick Pineault

YouTube

Instagram

Facebook

Friend/Family Member

Podcast

Share the name of the person or doctor that referred you