Wellness Clinic Intake Form

Welcome to The Church Of Ubuntu Wellness Clinic

First, please complete our wellness intake form below, with as much information as possible. If you or your carer are unable to complete this form for either health reasons, or internet limitations, please phone us and we will assist you.  +61 (0)2 4926 1881

*  Preliminary Assessment – $50. Once your wellness form is received and entered into our system our consultants read all your case particulars and create a comprehensive program for you including, diet, health, lifestyle, natural medicine recommendations and where to purchase medicines. You will then receive a personal phone call (and email) from one of our assistants, containing all of this information and how you can proceed. (first contact generally takes about 7 to 14 days from intake form receipt, assessment within 14 days pending our workload, with apologies). If you have any questions about the time and process please either email us at: info@churchofubuntu.org or phone: +61 (0)2 4926 1881

You may pay for your $50 preliminary assessment now if you wish to secure your place in our system.

Ensure clients name is on your payment.




*  Compassionate Care – The Church Of Ubuntu recognises that some people are suffering extreme hardship. We have a compassionate care program for those in genuine need. If you are in genuine need please discuss this with our assistants when they call, and they will assign you a compassionate care helper to discuss your situation. email info@churchofubuntu.org

The Church of Ubuntu is supported by many members of the community, we are a not for profit incorporated association. Our health consultants are all highly experienced and each one can offer a great insight into your health and well-being . The first step to wellness is to accept full responsibility for ones own health, we offer a much needed alternative to allopathic medicines, we aim to cure occasionally, relieve often, and comfort always. The Ubuntu Team.

Terms and conditions refund and returns policy

* Please note – You may encounter problems completing this form with a mobile handheld device.

Intake Form