Inquiry for working together
Thank you for your interest in working with me on your health! Tell me a little bit more about you below. Once your application is complete, we will be in touch shortly! I appreciate your patience, Kari
Sign in to Google
to save your progress.
* Indicates required question
First & Last Name
Date of Birth
How did you hear about me?
Are you located the U.S?
What lead you to want to possibly work together?
What line of work are you in?
What are your current symptoms, health challenges or concerns & how long have you been dealing with them?(list top 5 in order of importance)
What have you
tried in the past
to address your main health concern(s)?
How are you
trying to remedy those challenges or concerns?
What kind of support are you looking for- short term or long term? (Our practice is set up to be with you for years to come to support you in your health journey)
Short term/ I just want this issue 'fixed'
Long term/ I'm looking to better my overall health long term
Are you currently pregnant, breastfeeding or TTC?
Trying To Conceive
Not TTC, but would like to get Pregnant soon!
None of the above
Have you done any lab testing with your current provider?
Food Sensitivity Test
Cortisol / Adrenal Test
Organic Acids Test: OATS
Energy Work: Muscle Testing, Reiki Etc.
EMDR, Neurofeedback, other mental and emotional work
Would you like a free 15-minute phone conversation to assess your needs and the best next steps?
No, I'm fine with email communication.
If a phone call was requested, please leave your phone number!
Anything else you would like me to know?
Never submit passwords through Google Forms.
This form was created inside of a Natural Shift.