Form

STRUCTURED FLOW
12 week group lozenge program starting 2-22-23

$250 deposit to start. Total cost $3,360. Financing Available
*Application closes on 2-17-23

Participants must be 18 years old & California Residents

Two Assessments Required prior to participation

Participants must complete one Psychological & one Medical evaluation

For Transparency - Disqualifiers include but are not limited to: Client must have no significant medical history, specifically: uncontrolled high blood pressure, uncontrolled thyroid disorders, acute or chronic renal failure, currently taking antibiotics, cystitis, ocular abnormalities, history of psychosis, psychotic episodes or schizophrenia

Please fill out the application below to be considered for this program.
* Intake call and additional consents required with Sam Kabert

Email*

First name*

Last name*

Phone number*

Street address*

City*

State/Region*

What condition are we treating?*

I am 18 years old or older.*

Yes

I acknowledge that participation in Structure Flow by Sam Kabert is required.*

Yes

I acknowledge requirement of Diagnostic Mental Health Evaluation as part of the pre-screening conducted by Flow Integrative.*

Yes

I acknowledge requirement of Medical as part of the pre-screening conducted by Flow Integrative.*

Yes

Please tell why you are interested in Structured Flow*

Submit Deposit >>>HERE<<< To Be Considered