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Application to work with Dr. Kyrin
* Indicates required question
Email
*
Your email
First Name
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Your answer
Last Name
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Your answer
Email Address (Please "safe List" emails from
hello@kyrindunstonmd.com
to receive a reply)
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Your answer
Cell Phone Number
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Your answer
Do you currently live in the United States? Do Kyrin is currently only able to work with people residing inside the United States. Please do not complete questionnaire if you do not live in the USA.
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Yes
No
What is your main objective in working with Dr. Kyrin? Please provide details about any health challenges you are experiencing and the result you'd like to achieve.
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Your answer
On a scale of 1 - 10, how committed are you to this outcome?
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Not Committed
1
2
3
4
5
6
7
8
9
10
100% Committed
Which of these areas of your life are impacted by your current health situation?
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Relationships
Career
Social Life
Other
Required
What is the cost to you, in terms of finances, relationships and joy, of not solving your current health challenges?
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Your answer
If you don't fix your health problems what are you afraid will happen to you? Please describe.
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Your answer
Are there any activities or food changes you are unwilling to include in your life, no matter the positive impact they would have on your health? If so, please describe.
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Your answer
Are there any foods or activities that you are unwilling to give up no matter what the cost in terms of your health? If so, please list.
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Your answer
If selected, how much time are you willing and able to invest to address your health challenges, resolve them, and allow you to achieve vitality?
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An hour a week or less
Several hours a week
Several hours a day
Whatever it takes
What's the most you are willing and able to invest to resolve your health challenges and achieve brilliant health and vitality?
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$1,000 or less
$1,000-$3,000
$3,000-#5,000
$5,000-$7,000
Whatever it takes
Is there anything else you'd like to share with us?
Your answer
Thank you for completing our application. We'll get back to you within a few days to set up an appointment to discuss the opportunity further if we feel you are a good fit.
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