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

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Email *
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 currently 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) *
Are you currently pregnant, breastfeeding or TTC? *
Have you done any lab testing with your current provider? *
Would you like a free 15-minute phone conversation to assess your needs and the best next steps?  *
If a phone call was requested, please leave your phone number!
Anything else you would like me to know? *
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