Skip to main content

Medical Intake Form

Welcome to the Valhalla Vitality Platform! Before proceeding to our Wellness Shop, 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.


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.


Fill out Medical Intake Form

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


Get Approved!

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


Get access to all exclusive therapies

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


Explore your Client Portal

Manage your medical files from your personalized client portal


  • Register Your Self and Earn
    100 Points
  • Place an order and Earn 1 point on every $1.00 spent
  • Invite a Friend
    Earn 500 points for each accepted invitation
  • Earn on Someone Else Purchasing
    Earn 500 points for each accepted invitation
  • image
    Apply Points on Cart Total

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

Rewards Rewards
Hit enter to search or ESC to close