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Subscription to Naturopathic Health Services
This is an application to subscribe to low-cost naturopathic health services.
THIS IS NOT HEALTH INSURANCE
New subscription/Change of plan/Cancellation
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Information about persons included in the subscription.
Persons included in the FAMILY subscription must be IMMEDIATE family members or persons in the subscriber's care living in the same household. The household rule applies to family members who are ACTIVE students or ACTIVE military living away.
Family or group subscription
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Please select
Family/Individual
Group/Employer
Name of group/employer (if applies)
Select plan
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Please select plan
Plan A
Plan B
Plan C
Number of persons in the family enrolled in a subscription
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If there are more than six persons, contact us at 817-736-3004 or send an email to info@kulisz.com for a quotation.
Full names of persons included in subscription
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Please list all the persons included in the subscription. Separate names by commas. Please mark relationship: spouse-1, child-2, parent-3, other person IN YOUR CARE in your household-4
We will invoice your first month upon approval of this application (up to 48 hours). Your subscription will start 10 days from the date of payment. Subsequent invoices will be sent monthly on the same date and must be paid not later than 10 days before the end of the subscribed period.
Thank you for entrusting your health needs to us.