Confirm Your Program Structure:*

30 Days Dietary Transitions / 14 Day Detox (included)
Other

Select Your Alternate Program Structure:*

30 Days Dietary Transitions / 21 Day Detox
30 Days Dietary Transitions / 28 Day Detox
14 Days Dietary Transitions / 14 Day Detox
14 Days Dietary Transitions / 21 Day Detox
14 Days Dietary Transitions / 28 Day Detox
Other

NOTE: Additional customization and development fees will be required if you intend to change the content of the dietary transitions for the program. You will be required to submit these proposed changes on the customization form you receive after checkout. Our team will create a proposal for these changes as soon as we can confirm the details of the dietary changes you want for us to include.

NOTE: Additional customization and development fees will be required to create an alternate format. Our team will create a proposal for these changes as soon as we can confirm the details of the structure you want for us to include.

What options do you want for your supplement protocol?*

Fullscript Protocol (included)
Ortho Molecular Protocol (included)
Xymogen Protocol (included)
Ortho + Fullscript Protocol (included)
Non-Protocol Version (included)
Custom Supplement Documents and Videos

NOTE: There may be some additional customization and editing fees required for custom supplements based on your specific protocol. We will work with you to determine the scope of the changes required.

Which curriculum will you use as your base program?*

Standard Elimination Diet Program
Keto Program
AIP Program
Plant-Based Program

Program Add-Ons

Keto Program
AIP Program
Plant-Based Program

Revitalize Health Licensing Agreement*

I agree to the terms and conditions for licensing the Revitalize Health virtual curriculum

Product Name

Total

$0.00

Standard – Custom Branded Program (2 Payments)