Please fill out the questionnaire below and Dr. Kim will get back to you in 24 hours. Name * First Name Last Name Email * Phone (###) ### #### Zip Code How long have you been feeling unwell? 3 Months 6 Months 1 Year or Longer Do you have any existing health conditions that you think or know may be contributing to your symptoms? Please list. Do you drink unfiltered tap water? Yes No Do you travel frequently? How many times a month or year? Do you eat meals out often? How often out? How old are you? Are you under a great deal of stress -yes or no …and if so for how long? Do you have a private physician? Do you use alternative practitioners like a chiropractor or cranial sacral or massage therapist? Please list. What alternative therapies, supplements and prescriptions have you used or are currently using? Please indicate how you prefer to be contacted? DM/ text or email/ phone? Specify best time. Thank you!
