New Client Application


Request for In-Person Services

Below is our application to request services from Ewell Vernon. Ewell works in Mt. Airy, NC so applicants must be in or near this location.
We have included a Microsoft Word document and an Adobe PDF document below.

  • If you have Microsoft Word: download this document, click “Enable Editing”, complete the application, save it to your computer, and email to ewellvernon@gmail.com
  • If you have Adobe PDF: download this document, go to “Tools”, click “Edit PDF”, complete the application, save it to your computer, and email to ewellvernon@gmail.com
  • Because our one-on-one services require you to meet with Ewell, you can also download either document, print it, complete the application by hand, and then give it to Ewell in person.

If you choose to apply for my services, I will get back to you as soon as possible to help you begin your health and wellness journey!

Thank you,
–Ewell Vernon