Wellness Network Application

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Are you a health and wellness provider, or are you a health club or facility who provides services that promotes a Lifestyle of Health & Wellness?

If so, we are now creating valuable networks nationwide of practitioners and organizations who can assist local communities and small businesses reduce healthcare costs and help employees live healthier lives.

Please take the time to fill out the attached fact finder if you have interest in becoming a part of one of our networks.

Name Of Practitioner or Facility :

Phone Number?

Email Address?

What is your practice?

Massage & Bodywork

Strength & Conditioning

Metabolism & Nutrition

Western Medical Specialty

Eastern Disciplines

Psychology

Other Specialities

Martial Arts

Gym / Facility

Other:

Are you currently participating in any networks or do you offer discounts for being a part of any provider arrangements? If so, please tell us more about it?

Are you interested in doing on-site presentations to promote your services?

Yes - Always willing to give a free class, demo, or 30 min presentation on-site!

No - Unless I am directly compensated.

Maybe , but not sure yet.

Other:

Clear selection

Do you currently do any on-site corporate wellness? If so, tell us about it.

What do you do differently that gets results for your members or clients? Why do they like working with you or your organization?

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