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CLIENT PORTAL

Congratulations on taking this important step towards wellness and a better quality of life...
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Wellness Clinic Newcastle Intake Form

As a valued Ubuntu Wellness client, we welcome you to our purpose-built Resource Platform.

If you are an existing client please do NOT fill out this form again – PLEASE LOGIN first at the top of this page, you can access the client resource platform and update your profile details here

theportal.life has been created to support you with direct on-line ordering of all your favourite formulas and gives you access to new resource information and Practitioner services. Once you have completed the form, and have been approved by Admin, you can use your log in to order, update your information and more.

Before commencing this intake form, please ensure you read and understand our Privacy Policy and Terms of Service and our Association of Agreements Submitting the form below is an agreement of these terms.

  • The below questionnaire has been designed to help determine the most appropriate plant medicine protocol for you. This is an essential requirement for an initial consultation to assist in providing the correct on-going support for your wellness goals.

  • Ensure you have at least 15 minutes to complete the form in one sitting, or have essential information handy elsewhere on your computer for you to copy and paste as needed as you will not be able to save the form and come back to it.

  • If you are completing this form on behalf of a child, another person or an animal, please ensure your contact details are noted in the "Carers" section and only complete questions that apply to the relevant situation.

  • Initial investment  $150 – payable upon submission of form. This includes an initial 45 minute consultation, protocol recommendations, access to Sacred Herb Formulas, follow up and support for 1 month
    Your practitioner can discuss ongoing support and further consultations if needed, based on your personal circumstances. If you are experiencing financial difficulties, please contact us on the email below. 

  • After your form is submitted you will receive a welcome email that contains important information about your consultation and our Frequently Asked Questions (FAQ's) that may be helpful for you and your support team.

  • The email and password you select for your account will be your access to on-line product ordering and support resources.

    If you are completing this form on behalf of a child, another person or an animal, please ensure your contact details are noted in the "Carers" section and only complete questions that apply to the relevant situation

  • Please note that your application will be approved at the time of consultation which will then grant you full access to the site and NOT before. If you do not have a preferred Practitioner you will be connected with the most appropriate Certified Natural Lore Practitioner to suit your circumstances.

  • The email and password you select for your account will be your access to on-line product ordering and support resources.

If you have any questions or issues with this form please contact This email address is being protected from spambots. You need JavaScript enabled to view it. or call our Customer Care Hotline during work hours 0425 213 550

Medical History

Indicate your CURRENT levels of the below issues with a rating of 1 - 10 (1 being lowest and 10 being highest). Use how you would normally feel as the reference point:

Payment Information

$
I have read, reviewed and understand and agree to the statement of the Privacy Policy and Data Collection for healthcare services in this office as outlined by the above. Our Office has attempted to provide each patient with a statement of privacy policies. By signing up to this subscription plan and agreeing to the Privacy Policy you agree to this web site storing your information.

Portal Client Login

Login here to access the Practitioner range of products and our client RESOURCES.

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Call: 0415 207 887