Let's start with who you are...*

First Last

Business name*

Your email address in case we have questions*

What would you like to update?*

License number (Regulated by state)

Enter all license numbers that are regulated by state authorities and the applicable state.

Professional Board Certifications (if applicable)

Enter all professional board certifications, issuing body, state and other applicable information.

Educational degree for modality

Enter all educational degrees that pertain to your modality (degree, school, year graduated)

Certifications pertaining to modality

Enter all certifications you have earned applicable to your modality including what the certification is for, the issuer, and the year obtained.

TAGS: We help / support clients with...

Check all that apply. We reserve the right to make changes as appropriate

TAGS: Our training includes...

Check all that apply. We reserve the right to make changes as appropriate

Please make the following change(s) to my profile: About Us

What gives me joy about what I do...

Where we work with clients

At our office
Location will be discussed
Via phone or internet
At the workplace (NEW! Where you go to a business to provide services)

Services I offer and retail pricing:

You can list up to 5 services plus an initial consultation offer. Please provide your RETAIL PRICE or the total compensation for the service listed if you choose to discount. If your normal price is greater than $60, we will calculate how it will read in our directory (amount client pays at time of service plus our $60 payment per authorization code given to you by client). Remember, if your retail price is less than $60, we pay the lesser amount.

Services for free to client or at a discount

Do you offer a free initial consultation or any other special discounts or services to get clients in the door? Note: we reserve to omit items that do not fit into our model. This is not for the Healthy Living Savings Card

Healthy Livings Savings Card (optional)

If you wish to accept the Healthy Living Savings Card, what discount do you wish to offer? (We recommend at least 15-25% discount, but it is your choice). BE AS SPECIFIC AS POSSIBLE.

Healthy Livings Savings Card - Restrictions

If you are restricted to only offering services or products in certain states, please list areas where you can work with clients.

Healthy Living Savings Card Categories

Which categories should we put you in?

Activities, Retreats & Excursions
Business Development Tools
For the Workplace
From the Comfort of Your Home
Online Stores
Retail Stores and Healing Locations (even if you do not have a physical location - this is most everyone)

Title of your Wellness Education Program

The more intriguing, amazing, or humorous your title, the more often it will be selected.

A short description of your program

Wellness Education - Icons

Life Balance
Fitness
Nutrition / Healthy Eating
Emotional Health / Relationships
De-Stress
Financial Health
Our World (environmental)
Work Relations/Occupational

What icons do you want us to use? We reserve the right to make changes.

Wellness Education - Geographic listings

What geographical areas do you want this class posted to?

Compensation when You Define Wellness charges employers a fee

I understand I will be compensated up to $165.75 (65% of what You Define Wellness collects) if an employer has purchased a la carte wellness education, and no compensation if they have the Employee Wellness Benefit Plan as attendees will have sessions they may wish to use with me.

Yes
I will require an additional fee above this amount and will disclose it when an employer selects my class.

Languages

Besides English, what languages are you able to communicate in with clients/patients?

Upload a picture to your profile

Upload a document to be attached to your profile

Comments/Additional information:

Update Provider Profile

Update Your Profile

Upcoming Events

Sales Team Meeting

Let’s Get Acquainted – for healthy living professionals

Racial Diversity in the Healthy Living Professions

Toolbox for Appointed Providers