Intake Form Instructions

Welcome to your Energy Decode Assessment!

Please select your package below (Individual, Couples, or Family) and complete the required information.

Important:

Upload clear, natural photos (no makeup, no filters, natural lighting, face the camera directly).
Fill out the fields that apply to your selected package.
The more complete your responses, the more customized and powerful your Vitality Plan will be.

Once submitted, you’ll be directed to complete your payment.

We can't wait to decode your energy blueprint!

Which Energy Decode Package are you purchasing?

Name

First Name

Last Name

Email Used for Payment

Please include the e-mail you will use for payment

Is there anything you’d like us to know about your energy, health goals, or current challenges?

Allergies/Dietary Restrictions

Do you have any allergies or dietary restrictions we should know about?

Name #2

Only add if upgrading package to couples or family

First Name

Last Name

Name #3

Only add if upgrading package to family

First Name

Last Name

Name #4

Only add if upgrading package to family

First Name

Last Name

Name #5

Only add if upgrading package to family

First Name

Last Name

Intake Form Instructions