Request a Clinic Session

Complete this form to request a Clinic Session. Please note that you must accept The Longevity Center Terms and Conditions before you can submit this request.

We will try and accommodate your preferred date, but due to shifting schedule demands at the clinic, we cannot guarantee your preference.

You have any problems using this Request Form, please contact info@longevity-center.com.

    Your Name (required)

    Type of Session (required)

    Preferred Date of Appointment (required)

    Your Email (required)

    Phone number (required)

    Street Address (required)

    City, State, Zipcode (required)

    Referred by?

    Any comments or questions?

    Terms & Conditions:

    This class/clinic is intended to present information and techniques according to the instructor/therapist’s best knowledge and experience, and is to be used by the student at his or her own discretion. The adoption and application of the material offered in the class/clinic must therefore be the student’s own responsibility.

    I understand that this class/clinic is for the basic purpose of health maintenance, not for any treatment of any specific illness, injury or condition. I understand that the instructor/therapist, and his assistants, are not qualified to diagnose, prescribe, or treat any physical or mental illness, and nothing said or taught in class/clinic can be constructed as such. I understand that the class/clinic is not a substitute for any treatment by a licensed healthcare professional, and I will not attempt to use it as such.

    I release the instructor/therapist and his assistant(s), the author and publisher, and the owners and operators of the premises on which the classes/clinics are conducted, from any liability for my class/clinic participation and will hold him or her harmless for any results of this class/clinic.

    The information from the Class/Clinic is protected by Copyright law. The reproduction, written, electronic, and otherwise, in part or in whole, for commercial or personal purposes is expressly prohibited without prior written consent. Photographing, audiotaping, or videotaping are prohibited.

    Use of Master Hua-Ching Ni’s works and the Ni Family publications can only be used through proper authorization as stated in The Mentor Handbook of The Integral Way Society.

    The Longevity Center operates in accordance with California Bill SB577 for non-licensed professionals.

    By checking this box you agree to the terms and conditions set forth above.


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