Intake Form - Kari Lakomski

Let's get started

Thanks so much for requesting your free 15-min Health Insight Call. To ensure we make the most of our time together, please fill out this brief form. If we’re aligned, I’ll send you a link to book our call.

Name

Age

Gender Identity

Your primary health concern, struggles, or challenges:

What were your previous strategies to manage your health concerns?

Briefly describe your current diet/eating habits.

Are you currently taking any supplements? If so, please list them below along with their purpose.

Where would you like your health to be in 30 days? In 90 days?

What do you hope to achieve or gain from our coaching sessions together?