Your Journey to Peak Wellness Begins Here

At Amplify Health and Performance, we're committed to helping you achieve your best health. Our straightforward process is designed to get you results without unnecessary complexity.

STEP 1

Fill out our patient intake form

Complete our comprehensive intake form, laying the foundation for your personalized health plan.

STEP 2

Meet Your Health Partner

Have a conversation with one of our experienced healthcare providers. They're here to listen and guide.

STEP 3

Begin Your Journey

We'll create a personalized plan that fits your lifestyle and goals. Simple, effective, and tailored to you.

STEP 4

Experience The Difference

As you follow your plan, you'll notice positive changes in how you feel and perform. That's the Amplify effect.

Ready to take the first step? Let's work together to enhance your health and performance.

First Name *

Middle Intial *

Last Name *

Cell Phone *

Email *

Date of birth *

Gender

Male

Female

Preferred Method of Contact:

Shipping Address

Address *

City *

Country *

State *

Postal code *

Wellness specialist name, if assigned

*You can fast-track your sign up and get going right away!

Choose this convenient option to fill out your patient intake form and submit your information. After completing your patient consult fee of $299, you will receive an email with detailed instructions for visiting your nearest diagnostics center for blood work within 24-48 hours. This step ensures we gather all the necessary information to tailor your treatment to your specific needs.

Would you like to Fast Track?*

Yes

No

Driver's License *

Click to upload your file here

Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 10 MB.

Drivers License # *

Do you have insurance? *

Yes

No

Please upload your insurance card *

Click to upload your file here