Welcome! Please Fill This Pre-Screening Form First. It Should Take ~10 Minutes

Country *

Reason for Booking *

How would you like John Kim, Pharm. D. to help you in your healthy journey? *

What are the top 3 challenges you are facing with your health currently? *

What health goal would you like to achieve in the next 6 months? *

How committed are you to what you want most of your health? (10 being the highest) *

Not CommittedFully Committed

Are you willing to invest in the trasformation you desire? *

Yes

No

Are you currently working with a practitioner? If so, what is the name of the practitioner? *

What treatment have you tried so far that has worked and not worked? *

Are you taking any medications right now? *

Do you have any major trips planned in the next 6 months? *

Where do you spend most of your time — at home, at work, or elsewhere? *

How much time do you typically spend on your phone or other screens each day? *

What is your typical sleep schedule? *

What time do you go to sleep and wake up? (For example, do you prefer to go to bed when the sun sets and wake when the sun rises?)

What kind of diet do you have right now? *

Do you smoke? (John Kim, Pharm. D. does not work with smokers) *

Yes

No

Do you use any substances, such as marijuana, psychedelics, or other drugs? *

Yes

No

Do you have any known chemical allergies or sensitivities? *

Yes

No

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