Ready to Rediscover Your Youth?

Name *

First Name

Last Name

Phone

(###)

###

####

What services are you interested in?

Brain Health & Cognitive Enhancement

Longevity

Performance & Recovery

Energy

Immune Support

Vibrant Skin & Hair

Weight Management

GI Health

Individual Consultation

Advanced Laboratory Testing

When would you like to start your journey with us?

Select a time frame that best suits your schedule. This helps us prepare for your visit and ensure you receive the attention and services you desire right when you need them

As soon as possible

Within the next week

Within the next month

I’m flexible — Let’s find a time that works best

Refund & Dispute Policy

Refund and dispute policy: Services provided and packages are non-refundable once administered. Memberships may be cancelled at any time with 2 weeks notice. If you have a dispute, please contact our office manager at connect@fountainofyouthvail.com

I Understand & Agree

Cancelation Policy

Your appointment time is reserved just for you. A late cancellation or missed visit leaves a hole in the nurse's day that could have been filled by another patient. As such, we require 24 hours notice for any cancellations or changes to your appointment. Patients who provide less than 24 hours notice, or miss their appointment, may be charged a cancellation fee to the card on file.

I Agree