

READ ALL BELOW. NO STRESS IF YOU NEED HELP JUST CALL OR TEXT FOR ASSISTANCE: 860-603-3618
Welcome to Vitalized Performance Group (VPG Waves) We’re excited to support your wellness journey. Please follow the steps below to ensure your appointment can be booked and approved. To self‑book, simply scroll down.
1. Intake Form – Required for All New Clients
Every new client must complete the full Client Health Intake Form — either online or in our office. If you’re completing it in person, please arrive 10 minutes early.
All sections highlighted in yellow require your signature or initials. If any part of the form is incomplete, services may be denied.
If you have any contraindications (certain health conditions that do not qualify for the service) or any concerns, please call our office before booking your appointment.
2. Free Consultations – Phone or In‑Person
Consultations are always free, and you may choose either a phone consult or an in‑person consult.
After booking, just text me your first name and let me know:
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that you booked a consultation
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and whether you prefer a phone call or an in‑person visit 860-603-3618
Fast Easy: Client Online Intake form option/Mobil Friendly (automatically puts you in our system for easy booking)
Stay Connected:
Opt-in for text alerts and our newsletter to receive appointment reminders and occasional updates. Don’t worry—we won’t bombard your inbox! You'll only hear from us about special announcements, exclusive offers, free services, and Saturday appointments.
Bubble Circle Questions: Select one option (Y [Yes], N [No], P [Past]) for each.
Note: Missing answers for "Female" or "Male" questions will not prevent the form from saving or submitting.
A prescription is only needed if you have certain health conditions or if your doctor is referring you to us. For everyone else, our in‑house doctor can provide the required prescription at no extra cost.
Colon Hydrotherapy Blank Prescription Form
Have your MD, DO, APRN, or ND complete the form.
For clients with contraindications, your physician must fill out our forms.
Please note: Even with a completed form, the colon hydrotherapist reserves the right to refuse treatment.
Submit your completed forms by email to vpgwaves@vpgwaves.com or fax to 860-838-4664 (both HIPAA-compliant).

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