Windermere Longevity Enrollment

Windermere Longevity Enrollment

Welcome to Windermere Longevity. This form secures your place in our program with an $825 deposit. Your deposit covers your initial lab panel, annual physical, and 60-minute initial appointment. It will be applied toward your program balance if you choose to enroll at that visit. Please note that deposits are non-refundable, and enrollment is offered in limited numbers only. Submitting this form does not guarantee full enrollment; acceptance into the program is determined at your initial appointment.
Name*

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Blood Draw Preference?*
Please choose one so we know what lab kit to send
Initial Deposit – $825)

Your deposit is applied toward your program balance. At your initial appointment, you’ll select either the 6-Month Program ($2,000 total, $1,175 remainder due) or the 12-Month Program ($3,500 total, $2,675 remainder due).
Deposit
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Windermere Longevity Deposit-Required
Covers your initial labs, physical exam, and 60-minute provider consultation. This will be applied to your program fee upon enrollment.

$825.00

Advanced Cardiac Panel + Vitamins- Optional Upgrade
Initial basic labs are covered, if you wish to upgrade to add a more in depth look at your cardiac risk profile and vitamins please add. This does not go towards your program.

$499.00 Quantity

Total

$0.00
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
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Windermere Longevity Enrollment

Initial Deposit – $825)