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Aeternally Wellness Consultation

Intentional healing begins with a return to nature. This consultation helps match you with natural, earth-honoring remedies and wellness plans tailored to your unique rhythm and life force.

Birthday
Month
Day
Year
Gender
Woman
Man
Other
Blood Type
A
B
AB
O
Not Sure
Vaccinated?
Yes
No
Health Concerns / Possible Diagnosis
Habit
Upcoming or Pre-existing Surgeries
Yes
No
History of strokes?
Yes
No
Average Water Consumption
Eating Style
Average Exercise
Referred By / How did you hear about us?
Instagram
Facebook
Twitter / X
YouTube
TikTok
Website
Pinterest
Google
Radio
Ad
Magazine
Impowered Global
Kacy Garrick
Visus Studios Production Co.
Anima Speaks Foundation
Other
Are you completing this form for a minor between the ages of 0 - 13 years?
Yes
No

Aeternally Informed Consent and Disclosure

At Aeternally, we offer herbal products and holistic wellness services to support your personal wellness practices. This form explains the nature and limitations of our offerings and documents your voluntary participation.


Consultation and Client Information

The information you provide during your consultation helps Aeternally understand your wellness goals and preferences. By signing below, you confirm that the information you have provided is accurate and complete to the best of your knowledge.

Please disclose any known allergies, current medications or supplements, relevant health conditions, and whether you are pregnant or breastfeeding. Notify Aeternally of any changes before placing a subsequent order or participating in additional services.


Nature and Limitations of Our Offerings

Aeternally’s herbal products, consultations, and spiritual wellness practices are intended for general wellness purposes. They are not intended to diagnose, treat, cure, or prevent any disease and do not replace medical evaluation, diagnosis, or treatment by a qualified healthcare professional.

Information provided by Aeternally should not be used to discontinue prescribed medication, delay medical care, or disregard professional medical advice.


Potential Risks and Individual Results

Herbal products may cause allergic reactions, side effects, or interactions with medications and supplements. Consult a qualified healthcare professional before use, particularly if you have a medical condition, take medication, are pregnant, or are breastfeeding.

Individual experiences and results vary. Aeternally does not guarantee any particular outcome. Follow the product’s directions for use. If you experience an adverse reaction, discontinue use and seek appropriate medical attention.


Product Preparation and Order Processing

Orders requiring shipment are supplied in herbal form for preparation according to the accompanying instructions. For pickup or local delivery orders, Aeternally offers the convenience of preparing a one-week supply, where available.

Please allow up to three to five business days for order processing before shipment or local delivery. Shipping transit time is additional. Follow all preparation, storage, and use-by instructions provided with your order.


Voluntary Consent and Acknowledgment

By signing below, you acknowledge that:

  • You have read and understand the information in this form.

  • You have had the opportunity to ask questions and receive clarification.

  • Your decision to purchase or use Aeternally’s products or participate in its wellness services is voluntary.

  • You understand the potential risks, limitations, and absence of guaranteed results.

  • You consent to the products or services discussed during your current consultation. New products, changes in your health, or changes in services may require an updated consultation and consent.

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If you selected over five (5) or more health concerns or selected any of the following health concerns below, we recommend the Gold Remedy package:

​

  • Autism,

  • Cancer (Any type)

  • Cardiovascular/ Heart Concerns

  • Crohn's Disease

  • Diabetes,

  • Edema / Inflammation

  • Epilepsy

  • Fibromyalgia

  • GERD / acid Reflux 

  • High Blood Pressure

  • Irritable Bowel Syndrome / Stomach Problems

  • Liver Disease (Any Type)

  • Lupus

  • Multiple Sclerosis

  • Osteoporosis

  • Pancreatitis

  • Sickle Cell

  • STD (Any type)

Book Wellness Consultation
October 2026
SunMonTueWedThuFriSat
Week starting Sunday, October 18
Time zone: Coordinated Universal Time (UTC)Phone call
Sunday, Oct 18
10:00 AM - 11:00 AM
11:00 AM - 12:00 PM
12:00 PM - 1:00 PM
1:00 PM - 2:00 PM
Consultation Fee
$24.99

Intentional Next Steps

Important Note: This consultation is for wellness and educational purposes only and is not a substitute for professional medical care, diagnosis, or treatment.

01. Review

Our wellness practitioners carefully review your unique profile, concerns, and lifestyle goals to understand your body's specific needs.

02. Recommendations

Receive a personalized wellness plan featuring earth-honoring remedies and natural lifestyle adjustments tailored to restore your balance.

03. Follow-up

We stay connected to support your progress, offering ongoing maintenance and adjustments as you move through your deep reset.

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