Health & Goals Intake

A short, structured intake so we have the full picture before researching your question — instead of discovering important context five messages in. Most sections are skippable, and it only takes a few minutes.

Health & Goals Intake

A short, structured intake so we have the full picture before researching your question — instead of discovering important context five messages in. Answer only what applies; most sections are skippable.

About You

So we know who we're preparing this for, and how to reach you.

Name *

Email *

Phone (optional)

Please enter at least your name and email before continuing.

What's going on?

Tell us in your own words — what you want help researching, what you're experiencing, whatever feels relevant. There's no wrong way to answer this.

In your own words, what's going on?

How long has this been going on?

What changed immediately before this started?

New medication, hormone therapy, weight loss, a diagnosis, a major life event — anything, even if it doesn't seem related.

1. Basics

Age

Sex

Height

Current weight

Recent weight change

2. Current Therapies

Include medications, supplements, hormone therapy, and any GLP-1s / peptides / compounds — with dose and duration where you know it. Add as many rows as you need.

Any recent additions or dose changes?

3. Symptoms

Rate severity 1 (not a problem) – 10 (severe). Leave anything blank that doesn't apply.

Anything else you're noticing?

4. Lifestyle

Average sleep (hrs/night)

Sleep quality

Resistance training (x/week)

Cardio (x/week)

Approx. daily calories (if known)

Approx. daily protein (if known)

Hydration

Alcohol

Caffeine / stimulants

Any major recent lifestyle changes?

5. Medical Context

Major diagnoses

Surgeries

Pregnant, breastfeeding, or planning pregnancy?

Allergies / adverse reactions

Is your physician actively treating anything relevant right now?

6. Labs

No need to type results by hand — if you have a PDF or portal export, bring it to your research session and we'll identify what's present or missing. Just note the basics here.

Date of most recent bloodwork

Which of these were included? (check any you know were run)

Thyroid panel

CBC

Ferritin / iron

B12 / folate

Vitamin D

CMP

Glucose / A1c

Hormone panel

Lipid panel

Not sure

Anything notable from results you remember (optional)

Review & Submit

Here's a summary of what you entered. Submit it and we'll store it securely and prepare your research brief.

This questionnaire is for research and educational purposes only. It does not diagnose, treat, or replace a licensed healthcare provider, and nothing here is a recommendation to start, stop, or change any medication, supplement, or dose.

How this is used. When you submit, your answers are stored securely so we have your background on file, and used to prepare a research brief ahead of your session — you won't need to re-explain your context from scratch. You can also copy or download a plain-text copy for yourself.