Before we can welcome you as a new patient, the first step is this quick quiz.

This 5-minute quiz helps us understand your health concerns and see if our AlignHer Method™ is the right fit for you.

With the AlignHer Method™ you'll get a personalized path to feeling like yourself again using advanced testing, expert guidance, and whole-body therapies.

Step 1: This Quiz (5 minutes)

Take our quick quiz to share your symptoms and goals.
It helps our team understand your needs before your visit.

Step 2: Initial Consultation

Meet with Dr. Skrzypek to review your symptoms and history.
She’ll recommend the best AlignHer Foundations™ track for you.

Step 2: AlignHer Foundations™

Begin your 3-month root-cause reset.
We uncover imbalances, start repair, and build your personalized plan.

Step 3: AlignHer Ascend™

Continue optimizing and maintaining your progress.
Refine your plan, retest, and build long-term balance and energy.

Your Details

First Name

Last Name *

Date of birth *

Email *

Phone *

Question 1:

1. How ready are you to commit to lasting transformation—not just short-term fixes?

Question 2:

2. Our new patient program includes extended follow-up visits, health coaching, and personalized treatment over 6–8 months. Are you ready to commit the time for these touchpoints?

Question 3:

What is your main health concern?

3.1.1 My biggest health concern is:

3.1.2. How Severe?

3.1.3. What have you tried?

3.1.4. Did it work?

Question 4:

4.1. How are your health concerns affecting your life?

My energy & ability to get things done

My mood & emotions (irritability, anxiety, depression)

My sleep & recovery

My weight & metabolism

My confidence in my body

My relationships with others

My ability to enjoy food without discomfort

Question 5:

5.1. Have you worked with other practitioners for this issue? If so, what was your experience?

5.2. What do you feel needs to happen for you to get better?

Question 6:

Check any that apply in the last 6-months or so.

6.1. Fatigue & Energy

I wake up feeling tired even after a full night’s sleep

I experience afternoon crashes or energy dips

I rely on caffeine or sugar to get through the day

I feel “wired but tired” at night

None

6.3. Hormones & Menstrual Health (If Applicable)

6.4. Skin & Inflammation

6.5. Do you have any other symptoms which are not listed?

Question 7:

Tell us about your Diet and Nutrition...

7.1.2. Other Special diet or food restrictions:

7.3. How many meals do you eat out per week?

0-1

1-3

3-5

Question 8:

Tell us about your lifestyle and stress levels...

8.1. How well are you sleeping?

I sleep through the night & wake up rested

I wake up 1-2 times but fall back asleep

I have trouble falling asleep

I wake up multiple times & feel exhausted in the morning

I sleep well

8.2. What’s your stress level on a scale of 1-10? (1 = No stress, 10 = Overwhelmed)

8.3. How does stress affect you? (Check all that apply)

Question 9:

Do you have any of the following medical conditions? (Check all that apply)

9.4. Other Conditions:

Anxiety / Depression

High Blood Pressure

Migraines

None

9.5. Do you have any other condition not listed?

Question 11:

Tell us a bit about your Health Goals...

11.1. What do you hope to achieve from working with us?

11.2. When was the last time you felt truly well?

11.3. Did something specific trigger your health decline?

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Consent & Disclaimer

Please read and agree to the following before proceeding:

I understand that completing this form is for informational purposes only, does not create a patient-physician relationship with Dr. Karolina Skrzypek or Natura Integrative & Functional Medicine, is not intended to diagnose, treat, or replace medical advice from my healthcare provider, and that any information I share will remain confidential and used solely for assessment and consultation.

Please confirm you agree to the above consent and disclaimer *

I agree to these terms.