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Medical Intake Form

Welcome to Valhalla Vitality Community! Before proceeding to our Wellness Therapy Store, please fill out our Medical Intake Form.

Personal InformationStep 1 of 6


How to get full access to our Wellness Shop

Create an Account

Click Get Started and complete a small registration form.

1

Choose your therapy and book a consultation

Consultation is required to process your medical intake form, choose the best therapy and provide you access to prescription products.

2

Fill out Medical Intake Form

Let us get to know you better, fill out our Medical Intake Form

3

Get Approved!

We will be in touch with you regarding your provider Consultation and account approval!

4

Get access to all exclusive therapies

Visit our Wellness Store to browse a wide selection of therapies.

5

Explore your Client Portal

Manage your medical files from your personalized client portal

6

Rewards
  • Place an order and Earn 1 point on every $1.00 spent
  • Invite a Friend
    Earn 500 points for each accepted invitation
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    Apply Points on Cart Total

    Conversion Rule : $1.00 = 50 points for each accepted invitation

Rewards Rewards
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