Enrollment Application Form

**PLEASE NOTE: This is not a FREE Program, although we do our best to make it affordable for everyone. Are you willing to invest some of your own time and money towards healing yourself?

Yes! I am ok with investing in my health!

Are you Pregnant or Breastfeeding?

YesNo

How did you find out about Ginger?

What are your main symptoms (check all that apply)

**If you have a partner, spouse or family member that contributes to your health finances, we recommend that you bring them to this call. Will you 100% block off the time to show up at the time you pick? *

Yes Absolutely!

If you were to find a way to heal your body, would you be able to invest in getting the help necessary to get there?

Yes! I have the cash and/or credit to invest in myself and my health.No, I am broke, maxed out month to month or don't have access to credit.

I agree to receive occasional emails (we promise no spam & opt out anytime)

I agree to the GDPR Terms & Conditions