Application to work with Dr. Kyrin
Email *
First Name *
Last Name *
Email Address (Please "safe List" emails from to receive a reply) *
Cell Phone Number *
Do you currently live in the United States?  Do Kyrin is currently only able to work with people residing inside the United States.  Please do not complete questionnaire if you do not live in the USA. *
What is your main objective in working with Dr. Kyrin?  Please provide details about any health challenges you are experiencing and the result you'd like to achieve. *
On a scale of 1 - 10, how committed are you to this outcome? *
Not Committed
100% Committed
Which of these areas of your life are impacted by your current health situation? *
What is the cost to you, in terms of finances, relationships and joy, of not solving your current health challenges? *
If you don't fix your health problems what are you afraid will happen to you?  Please describe. *
Are there any activities or food changes you are unwilling to include in your life, no matter the positive impact they would have on your health? If so, please describe. *
Are there any foods or activities that you are unwilling to give up no matter what the cost in terms of your health? If so, please list. *
If selected, how much time are you willing and able to invest to address your health challenges, resolve them, and allow you to achieve vitality? *
What's the most you are willing and able to invest to resolve your health challenges and achieve brilliant health and vitality? *
Is there anything else you'd like to share with us?
Thank you for completing our application. We'll get back to you within a few days to set up an appointment to discuss the opportunity further if we feel you are a good fit.
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This form was created inside of Kyrin Dunston MD LLC.