Click here to open PDF of form. Please print this form, fill out, and send it to the address below.
Include a copy of your last tax return, insurance information and a photocopy of a photo ID. (Drivers license is acceptable)
Visionary Alternatives, Inc: 7725 Kenway Place
Boca Raton, FL 33433
We are presently unable to fund any treatments due to lack of funding. Raising awareness about the effectiveness of alternative treatments is our only hope. Thank you.