Book a FREE Discovery Call Name * First Name Last Name Email * Phone number * Date of Birth MM DD YYYY Gender Female Male Other In general would you say your health is: excellent very good good fair poor Please describe your problem and symptoms A few short paragraphs will suffice. Which services are you interested in? Personalised health assesment Advanced medical testing Bespoke health coaching Nutritional advice Lifestyle coaching Not sure What would you like to change about your health? In the past 7 days, how often have you been bothered by emotional problems such as feeling anxious, depressed or irritable? Never Rarely Sometimes Often Always In the past 7 days, how would you rate your fatigue and levels of energy? Mild Moderate Severe Very severe I consent to sharing this data with Lantern Clinic and I understand that this form will be submitted to their email address * I consent By submitting this form you will be on the Lantern Clinic mailing list. Please click if you wish to opt out. I wish to opt out Thank you for submitting a request for a discovery call with Dr Margarita. We will contact you soon to arrange a call.
