Non-Medical Supervised Water Fast Attendee Application

January 30th - March 13th 2027 **includes arrival and departure days

To get started with the Application for the "Detoxification, Cleansing, and Healing in Costa Rica" with Dr. Douglas Graham, D.C., please enter all your details and click the "Fill Out Application" button. 

Spots for this event are extremely limited and will be allocated on a first-come, first-served basis for completed applications.

After you complete your application, Dr. Graham, D.C., must still approve it.

We will notify you when your application is approved and send you the payment link.

Your deposit payment must be received before your spot at the event is reserved.

We care about your health and fitness, and to ensure the quality of our events, we must review and verify your Water Fasting application with Dr. Graham, D.C., before you can participate. 

We want to be sure that this program is right for you at this time.

Please take the necessary time to fill out the form fully and completely, and we will contact you very soon to discuss your place at our fasting event.

IT IS CRITICAL THAT YOU ANSWER ALL QUESTIONS FULLY AND TRUTHFULLY! Make sure you have all the information before you start filling out this form.

NOTE: All fields marked with an asterisk (*) are required.

You cannot submit this form without filling in all required fields, and it will not save a partially filled application's information. If you are not able to complete and submit this form, you can click to apply again in order to start again when you are ready.

Or you can Schedule a Call with Dr. Graham here

Once Dr. Graham, D.C. has reviewed your application, he will contact you at the email address you provide below. If accepted and there is still space left, you will be provided with payment details.

Contact Info for Attendee

Choose a country (click the country below to choose another if needed)

Personal Info for Attendee

Lifestyle Info for Attendee

Health History for Attendee

Pregnancy, Childbirth, Breastfeeding

Goal and Background

We wish to help you in reaching your goals; not to superimpose ours on you. A clear understanding of your goals and background will help us stay focused.  This list may be short or long, specific or general.

Special Needs of Attendee

Emergency Contact Info

Those to contact in case of attendee's emergency while attending (you must specify at least one emergency contact):

Additional Info