Intake Forms

Begin your healing journey with Moby Botanicals.

Our online intake forms are HIPAA compliant and password protected.

Individuals can fill out our intake form here.

To fill out an intake form on behalf of a loved one in a residential facility, please fill out our intake form here.

If you haven’t been given a card with the password, please reach out to begin a conversation.

Submitting an intake form is the beginning of our focused onboarding process. This form provides us with critical information required to move forward with assisting you. Once received, we will reach out to schedule an appointment for a call, please allow a minimum of 1 hour for this initial conversation. We charge a fee of $250.00 ($200.00 for Hospice clients) for initial intake. You will be invoiced upon submission of the form.

Properly Dosed Medicine

Initial intake includes:

An in-depth review of your unique situation.

Design of your custom protocol.

Your first order of medicine (will last a minimum of 3 weeks).

Delivery (or pick-up) of your first order.

Ongoing phone support throughout your ramping up process.