Appointment Form

 
 Please Note: Appointment Scheduling for Full Body Iridology Scan is available all day every day. To speak with a Health Scan representative, call (519) 259-4334. All information on this form will be transferred by encrypted means for review by Health Care staff. Someone will contact you within 24 hours to discuss your appointment and/or to confirm time, date and location.
Full Body Iridology Test is $199.00 You may qualify for a $50 discount if you are a member of one of our civic related groups, including:
 Registered Medical Groups
 Registered Spiritual Group
 Registered Trade Unions
 Registered Service Clubs or Associations


You must remember to enter your organization's coupon code below in order to qualify for your $50.00 discount, which will be deducted from your deposit amount ($100.00 - $50.00). The Discount will show in your checkout before you make your payment. If you do not have a coupon code, please get one from your organization or call the doctor to get one.


If your group is not yet registered with us, why not suggest it to your organization's leadership team? You may want to join our affiliate program to earn finder's fees.

For Non-Members of Qualified Groups  
 Regular body scan appointment fee  $199
 Deposit required when you register below  $100
 Balance to pay at your appointment  $99
For Members of Qualified Groups Only  
 Regular body scan appointment fee  $199
 Deposit required when you register below (You must enter coupon code at the bottom of this page)  $50
 Balance to pay at your appointment  $99

The $100 balance must be paid at the appointment location before you can have your test.
Note:
Deposit fee is non-refundable.

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Accepted Payment
Methods

PayPal or Credit Card - secure credit card payment
Your Name
Your First & Last name
Your E-Mail Address
A confirmation email will be sent to you at this address
if you do not have an email address you can click here to get a temporarily email.
Choose a Login Name (User ID)
It must be 4 or more characters in length and may only contain small letters, numbers, and the underscore '_'
check for uniqueness
Choose a Password
Must be 4 or more characters
Confirm your password
Enter password again
Pick a date Click here for calendar
City Doctor/Iridologist Phone Number
ADDRESS INFO
Organization Coupon Code
Coupon Code
if you get any coupon code from an organization,
please enter it here