3x4 Genetics Application & Questionnaire
Thank for your interest in our 3x4 Genetics consultation!  My Lifestyle & Functional Medicine private practice is very unique and innovative. It's less of a "doctor's visit" and more of a "guided partnership" to sequence your steps to better health. There are several important questions that I request you answer before scheduling your consultation. In addition, once you complete and submit this form, your 3x4 Genetics test will be ordered.

After you have scheduled your appointment, you will received additional emails to establish an account with the medical record system that I use.  It is called Charm.  Once you have established an account, the system will alert you to complete an indepth questionnaire in Charm.  Providing answers ahead of time will allow me to maximize our one-on-one time together.

Thank you so much for taking the time to complete this application!

Have a wonderful day!

--Dr. Carina
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Email *
First and Last Name *
Age *
Phone Number *
What is your mailing address (necessary for ordering the 3x4 Genetics testing)? *
Dr. Hopen is a licensed physician in the state of Washington.  She is only able to render care to individuals who are physically in the state of Washington.  Are you physically in the state of Washington? *
What top 2 medical struggles are you seeking help for? *
Why do you feel a comprehensive, 3x4 genetic testing may be right for you, and WHY IS NOW the right time? *
What do you think your BIGGEST OBSTACLE(S) might be to feeling more vibrantly? *
During this consultation, I prefer to spend our time understanding you and your goals. Did you know you we offer membership packages  and you can learn about the details ahead of time (pricing, terms and conditions, testing and supplements, etc.)? (choose one) *
What is the ONE QUESTION that you want to make sure is discussed during your consultation? *
How did you hear about my services?  If applicable, please list the referral name. *
Please list the referral name below (if applicable)
Description of the 3X4 Genetics Bundle
This bundle offers a personalized plan that gives you insights that help you understand your health better, with clear and actionable recommendations to help you improve your quality of life. It’s not invasive at all, it only requires a cheek swab that takes 30 seconds.  This package is a great option for the DIY action taker who would like more objective information on how to optimize their health.  It is also for the individual who has been told "everything is normal," but you have done everything you can, and you know that an underlying health issue is yet to be uncovered.  
Consultation Bundle Fee (does NOT include lab):  $489 (Regular price $847)

Consultation Bundle includes:
1.  20-minute initial in person visit and
2.  40-minute follow-up to review results
3.  Lifetime access to Inspired Wellness Academy course of choice (value $39-119)
4.  2 month access to LivingPlateRx online meal planner

3x4 Genetics Lab Test fee $349:  This test is a SEPARATE transaction fee that the client pays directly to the lab company.

The genetic test can only be ordered after confirmation that your initial 30-minute consult appointment has been scheduled.  After the lab test order has been submitted by Dr. Hopen, you will receive an email from the lab company for electronic payment. After the payment by the client has been received, the lab company will mail the test directly to your home.  Currently, the turnaround time for results is between 4-5 weeks.
Please use this link to purchase your 3x4 Genetics bundle (does NOT include lab test).  You will be charged a TOTAL fee of $489 and you will also have an opportunity to schedule your initial 20-minute visit at that time.  
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