Home Detox Program Registration Form


If you would like to experience the home detox program, please do go ahead and fill in this form,  specifically indicating where you live/where the kit will be shipped to so that I can notify you when they become available!

  • Please include area code
  • Please list any illnesses or health issues you are currently dealing with. And please list all present medications and/or treatments.
  • Please list here any food allergies or strong dislikes.
  • What would you like to accomplish by participating in this program??
    PLEASE READ AND CHECK* The Amaveda detox program is for educational purposes and is not intended to treat, cure, mitigate or prevent any disease. Any participant with a serious medical condition or taking prescription medication should check with their health care practitioner before following the detox program. The physician who has prescribed any medications you are taking must be aware of your intention to follow a detox program. I have read the above statement and agree to take full responsibility for any results this program may incur. I have read and agreed