---
title: "Application"
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canonical_url: "https://www.pacificawaterfasting.com/application"
markdown_url: "https://www.pacificawaterfasting.com/llms/funnel/application"
lastmod: "2026-07-28T17:32:38.986Z"
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# Application

## Entry: Landing Page

## Begin Your Consultation

Every participant begins with a health screening to ensure therapeutic water fasting is safe and appropriate for their individual needs. 

Complete the questionnaire below, providing as much detail as possible about your current health, medical history, medications, and wellness goals. Your submission will be reviewed by our medical team as an initial assessment to determine whether you may be a suitable candidate for therapeutic water fasting.

If you appear to be a suitable candidate, you'll be invited to submit your consultation deposit and book a one-on-one Water Fasting Consultation with Dr. Ariel Jones, ND. During this appointment, Dr. Jones, ND will complete a comprehensive medical assessment, discuss your health goals, and recommend the fasting program that's best suited to your individual needs. If therapeutic water fasting is not appropriate at this time, you'll receive guidance on your next steps.

Please complete this questionnaire as thoroughly and honestly as possible. Your initial screening is based entirely on the information you provide. Omitting medical conditions, medications, or relevant health history may affect your eligibility and could result in therapeutic water fasting being determined to be inappropriate during your consultation.

Submitting this form does not commit you to purchasing a program. It is simply the first step in determining whether therapeutic water fasting is right for you.

## Step: Thank You

# Thank You

Thank you for completing your health questionnaire.

Your information has been received and will be reviewed by Dr. Ariel Jones, ND. She will contact you to schedule your medical intake consultation, where you'll discuss your health history, wellness goals, and whether therapeutic water fasting is the right approach for you at this time.

If additional information is needed, or if there are steps you can take to become a better candidate for fasting in the future, Dr. Jones will discuss these with you and work with you to develop a personalized plan.

We appreciate your interest and look forward to connecting with you.

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