Wellness provider application

Apply to join the BalanSpa LLC wellness provider network. We'll review your application and be in touch.

Your information

First name *

Last name *

Email address *

Phone number

Which services do you offer? *

Service areas

Cities or areas where you can travel for on-site events.

Optional — providing your license details speeds up the review process.

License state

License number

License expiry

Do you carry general liability insurance?

Travel radius

How far you're willing to travel for on-site events.

Bio / professional background

Résumé / CV (optional)

Upload PDF, DOC, or DOCX — max 10 MB

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Which days are you generally available?

Availability notes

Additional notes