Returning Client Consultation

Dear Returning Client,

After completing and submitting the shorter follow-up form below, you will be prompted to schedule a consultation time with me via my online booking system.

Warmly,
Kristina

* First Name: (required)

* Last Name: (required)

* Your E-mail: (required)

* Confirm E-mail: (required)

* Phone: (required)

* Are you an international client? Enter YES or NO. (required)

International clients only: How would you prefer to call Kristina? Check one:

WhatsApp AudioFaceTime AudioStandard Phone Call

* Street:
* City: * State: * ZIP:
Country (if outside USA):
(mailing address required)

* Date of Birth: (required)

* What health challenges are you currently struggling with? What has or has not changed since your last appointment? (required)

IMPORTANT:

Submission of this form may take up to 30 seconds after the Submit button is clicked. Thanks for your patience. Please do not refresh the page or use the back button!

The Optimal Health Network respects the privacy of its clients. All personal information provided on this secure form will be held in strict confidence and will not be released to any third party without prior written authorization.