VIP Membership Application Form Medical Intuitive Naturopathic Wellness An Exclusive Path to Fast Transformative Healing Personal Information Please fill out the form below to apply for our VIP Membership. This is a selective, high-demand program, and we are committed to ensuring the best fit for both your health and our practice. Full Name Birth Date Email Phone Number Mailing Address Preferred method of communicationPhoneEmail Health & Wellness Goals Please answer the following questions to help us understand your health needs and goals for joining our VIP Membership Program. What are the primary health or emotional challenges you're currently facing? Have you been diagnosed with any chronic health conditions (e.g., autoimmune diseases, hormonal imbalances, etc.)YesNo If yes, please specify Are you recovering from a major illness or injury?YesNo If yes, please provide details Do you experience stress, burnout, or emotional overwhelm?YesNo If yes, how do these affect your life? What is your primary goal for enrolling in the VIP Membership Program? Are you currently working with any other healthcare providers (e.g., doctor, therapist, naturopath)?YesNo If yes, please provide details Health & Wellness Goals Are you willing to commit to the full VIP Membership program for a year?YesNo Do you understand that this program is designed for individuals who seek immediate, transformative care and that you will be expected to actively participate in your healing journey?YesNo How do you plan to prioritize your health while participating in this program? Additional Information Have you ever worked with a medical intuitive or energy healer before?YesNo If yes, please share your experience What do you hope to achieve through working with Silvia Tran and her team? Are you open to receiving guidance and support for emotional or spiritual growth, in addition to physical healing?YesNo What are your expectations for the VIP Membership Program in terms of care and communication? Final Considerations Do you agree to the terms outlined in the Membership Agreement, including cancellation policies, session terms, and confidentiality requirementsYesNo Are you prepared to invest in your health and wellness through the VIP Membership Program?YesNo Signature By typing my name in this field, I understand and agree that this is a form of electronic signature. Date Submission Instructions Once you complete this form, please submit it to [Insert email/website link] for review. Our team will contact qualified applicants for a brief consultation to further discuss your application and determine the best path forward. Thank you for your interest in the VIP Membership Program. We look forward to partnering with you on your transformative journey to health and wellness. If we believe that you are a good match, we will reach out to schedule your consultation.
