For all new patients, I ask that you please fill out the Forms below. Thank You!

For new patients who do not reside in Ohio, please complete the following form below

Client Payment Information

A Life Nourished LLC. is a cash-based business, accepting all major credit cards and personal checks. Some services require a down payment.

A Life Nourished LLC. does not accept insurance as a form of payment nor will complete medical claims (provide diagnosis codes, procedure codes…etc). A Life Nourished LLC. is happy to provide invoices that with all necessary identifiable practice information (EIN, RD License number) so that clients may submit on their own accord.