Skip to content

Wellness Embassy License Qualification and Form

Operation Wellness Storm – Pre-Qualification Check List Wellness Embassy

This will be an online interactive survey and capture page.

Thank you for enthusiastically responding to our call for Wellness Embassy Ambassadors to help serve the Veterans who serve us. These are exciting times as a new avenue of care is being blazed for Chiropractic and you. You will get to be part of this revolution as it unfolds. ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••
Below are a series of questions and statements. Please check all that apply to you. ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••

In light of the Executive Order on Mental Health, as well as new legislation that supports this non-pharmacological approach, I am very interested in engaging vets as patients and serving them.

  •  I understand the sense of urgency our Nation faces and I am willing and able to rise up to the challenge. I want to be part of this now.
  •  I would like to undergo the training necessary to become a provider of these diagnostic and treatment protocols.
  •  To receive pre-qualification training, I will set aside 1 hour per day for our initial 1 week bootcamp.
  •  I am enthusiastic about helping Veterans with PTSD, Anxiety, Insomnia, and Depression.
  •  I am enthusiastic about helping others with PTSD, Anxiety, Insomnia, and Depression.
  •  I am interested in helping Veterans or others for concussion.
  •  I believe that providing scientific studies that validate my recommendations for nutrition and care will increase patient compliance and referrals.
  • As a Wellness Embassy Ambassador, the website will be personalized and filled out to contain a library of educational materials, patient education software, training, support and outreach for new patients.
  •  I will use the website for patient education and Veteran Outreach.
  •  I will use the website as a tool to position myself as a CAM consultant to other health professionals.
  •  Using the marketing materials, lectures and seminars, I will be able to influence at least 5 colleagues to participate in this program.
  •  If Operation Wellness Storm comes to my city for some special training, I will be able to have in attendance at least 10 fellow Chiropractors and other Doctors at a luncheon Wellness Embassy would host.
  •  I am willing to email 1,000 information packets every month to patients and healthcare professionals in my territory. (leads are one of the package options)
  •  I understand that proprietary information, including equipment and treatment protocols will be shared as a part of this training, and I agree to keep confidential such information as is not currently available to the general public.
  •  I understand that Phase II of this training program includes some new hardware or equipment.
    I have:
  •  CLA SubStation
  •  NeuroInfiniti
  •  Tytronics
  •  MyoVision
  • ProAdjuster/SigmaAlin
  • Activator
  • ArthroStim
  • NeuroMechanical
  • LaserAcupuncture
  • LLLT
  • Decompression
  •  I want to be considered a first option in my area.  I want to help manage the clinicians in my region.

If you checked 10 out of 17 of these questions then the next step is to arrange a personal conference call between you and the OWS team.

I, (Print Name)___________________________________ acknowledge the need to act now to provide a better solution than drugs to our veterans. As a Chiropractor I feel it is my duty to take action now. I am interested in getting more details (via webinar) on the training and certification program for providing effective and natural health care to our veterans, and that their best interests would be served by a non-pharmacological approach geared to help them without risk of further damage or injury.

I am requesting a telephone interview for us to mutually determine my qualifications to participate in this program of healing and the new Brain / Spine- based Wellness Paradigm.

I have signed the NDA and will return it (scanned or faxed) along with this Application Request.

I’m able to have a telephone interview this week.

Signed:____________________________________ Date: ____________ Print name:__________________________________________________ Address:____________________________________________________ Phone:___________________ Email:_____________________________

Please provide 3 times in the next 5 days that you can be available for a phone interview of approximately 30 minute’s duration. We will confirm back with one of your choices.

1. Date:__________________ 2. Date:__________________ 3. Date:__________________

Time:__________________ Time:__________________ Time:__________________

Visit and checkout some of the items we have turned on for your preview.

Included with this Questionnaire: NDA