I, on
have scheduled to order and purchase a
3 Day : The Kick Start $1545 Day : The Reset $2497 Day : Detoxology $346Digging Deeper : Pre-Cleanse Consult with Christy 30 MinutesJuice + Crunch Apply to any Cleanse Package
Scheduled to be:
Picked up on at / after .
Delivered to:
As the Delivery Address is typed, please select address from the generated list above input field.
Distance from our Commissary:
My telephone number is:
and my email for confirmation:
Age: Weight:
Allergies:
Medications:
Ailments/Disease/Disorders:
Reason for doing a cleanse:
Dietary regimen and restrictions (caffeine, soda, processed foods, sugars, etc.):
Vegetable, spice, herb, or fruit aversions:
Additional special instructions for cleanse juices:
Credit card information is taken when a cleanse is booked, and charged when you pick up your cleanse unless you choose to process that day. An emailed confirmation will contain links for pre-payment if you so choose.
Cancellations must be made 48 hours in advance prior to picking up or delivery of your cleanse. You will not be charged if cancellation is made 48 hour or more in advance. You can do so by calling or emailing. Please make sure you speak to someone personally to avoid any miscommunication.
Unfortunately we do not offer any refunds or credits for cleanses cancelled less than 48 hours before your scheduled pickup/delivery time. You will be charged in full for the price of the cleanse for any cancellation made after the 48 hour threshold, and/or failure to pick up your cleanse.
I have read, acknowledge, and understand Beet Street Juicery, LLC Cleanse charge and cancellation policy as stated above.
I have honestly and willingly shared my health information as inquired during my consultation to the best of my knowledge, and for my own safety. This includes information on any of the following: ailments, disease, disorders, allergies, conditions, illnesses, list of prescription and over the counter medications, dietary regimen, and dietary restrictions.
I understand that Beet Street Juicery will not be held liable for any information I have/did not disclose during our consultation. Beet Street Juicery will not be held liable for any information I have not disclosed.
I acknowledge that Beet Street Juicery has referred me to first consult my physician before entering into this day juice cleanse, and I accept full responsibilities for my actions in my decision to pursue this consultation or not.