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Membership Request Form By requesting to join today, you acknowledge that you have read and agree to the terms and conditions of the online Membership Agreement and Privacy Practices.   Payment is available with PayPal, Visa, MasterCard, or Discover. Payment information is required to schedule your appointments. If you prefer to contact us by phone to provide your information, please indicate your preference below and call (361)494-0088.  A Welcome e-mail will be sent to the e-mail address you provide which will confirm your selected options. Your patronage and the opportunity to serve you is appreciated! First Name: * Last Name: * Address Street 1: * Address Street 2: City: * State: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code: * (5 digits) Daytime Phone: * Evening/Alternate Phone: Email: * Birth Date: * Emergency Contact and Phone Number: * How did you hear about us?: * Check all membership options that you wish to add: Pain Management Chronic Illness/Home Bound Care Weight Loss  Advanced or Anti-Aging Skincare Skincare 45+ Skincare 35+ Skincare 25+ Skincare 13+ Pediatric Skincare Make-up Tips and Tricks Blood Type Analysis (Pricing may vary and product purchase may be required.) Type of credit card you wish to provide, card number, full name on the card, billing address, expiration date, and 3 digit code on the back: * Indicate preference to be contacted by telephone for above card information or comments here: Enter comments here!