Nature of Your Inquiry*
---Would like to schedule an appointmentWold like to speak to someone

Health Conditions You Would Like Help With*

First Name*

Last Name*

City*

State*
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Email*

Phone*

Best Time To Call

How did you hear about LifeWorks?*

I UNDERSTAND AND AGREE THAT:

I am not an existing patient of LifeWorks.
I will have to travel to Clearwater, Florida for a consultation, lab-testing and treatment
LifeWorks does not accept medical insurance Medicaid or Medicare
I will have to pay for my initial consultation at the time of scheduling
I may be required to stay in Florida for the duration of my treatment
LifeWorks does not refer patients to other clinics