Before we begin

Let's get the full picture.

The more honest detail you give, the more precisely we can read your bloodwork. Answer what you can — estimates are fine, “I don't know” is a real answer, and your progress saves automatically as you go.

Who's filling this out?

Which units feel natural to you?

Chapter 1

Who you are.

The basics that calibrate every reference range to your body.

Legal name

Preferred name

Date of birth

Gender identity (if different)

Sex assigned at birth

Height

Current weight

Optional A few more details that sharpen the read

Weight ~6 months ago

Weight ~12 months ago

Waist

Where you live (city is fine)

Moved across a big elevation change in the last 3 months

Genetic ancestry — select all that apply

Chapter 2

What you take.

Every prescription and over-the-counter drug. Don't forget creams & serums (hair-loss, hydrocortisone, hormone creams), inhalers, nasal sprays, injections, patches, birth control, weight-loss shots, and acid reducers — patients almost always leave these off, and they quietly change lab results.

Chapter 3

Supplements & what they did.

Form matters (methylfolate vs folic acid; magnesium glycinate vs oxide), so note it where you can.

Optional The story of what worked and what didn't

Anything that clearly worked

Anything that did nothing (real dose, real duration)

Anything that made things worse

Chapter 4

Your history.

Blood transfusion or IV iron in the last 3 months

Optional Diagnoses, surgeries, allergies & family

Conditions you've been diagnosed with

Surgeries & hospitalizations

Allergies & bad reactions

First-degree family history — with the age it started

Chapter 5

Day to day.

How do you eat?

Alcohol — drinks per week

Tobacco / vape / nicotine

Your build

I take creatine

Optional Digestion, sleep, stress & the rest

Bowel movements — how often

Typical stool form (Bristol)

Bloating

Reflux

Known gut conditions

Changed how I eat a lot in the last 3 months

Hours of sleep

Sleep quality

Night or rotating shift work

Sleep-apnea screen — tick any that are true

Loud snoring Someone's seen me stop breathing Unrefreshing sleep Morning headaches

Current stress

Major life events or trauma, past or present (only if you want to share)

Last alcoholic drink before the draw

Caffeine per day

Cannabis

Other recreational

Exercise — type & how often

Chapter 6

Hormones & blood loss.

Any hormones you take — select all that apply

Regular blood or plasma donor Therapeutic phlebotomy (e.g. for high iron)

Chapter 7

Your story.

This is the part the numbers can't tell us.

In your own words — what's the main reason you're here?

Your top goals, in order — add at least one

Optional The deeper context that makes the plan yours

When did you last feel completely well? What was that like?

When the main problem started

Is it…

What else was happening in your life around then?

How fast is it changing

What do you think is causing this?

What do you fear most?

What would “better” actually look like for you?

What's already been checked or tried — and the results?

Chapter 8 · optional

Your numbers.

If you happen to know your healthiest-ever values, they're gold — they let us read each result against your own baseline, not a population average. Skip freely if not.

Personal baselines

I have prior lab results to share

I have genetic / pharmacogenomic results

You can send the actual files to the clinic separately — just flagging that you have them helps.

Chapter 9 · the high-value one

About your blood draw.

These small facts decide whether a result means what it says. Worth the two minutes.

Date of the draw

Clock time

What time you woke that morning

Hours fasted

Had water beforehand Had coffee beforehand

Hydration that morning

Took biotin in the 72 h before (hair/skin/nail, “energy”, B-complex) Iodine load in the last 2–4 weeks (CT dye, kelp/seaweed, amiodarone, povidone) Strenuous or unaccustomed exercise in the 24–72 h before Infection, illness, injury, surgery, or vaccine in the last 4 weeks

Your usual meds/supplements the morning of the draw

Any NSAID / pain reliever in the 7 days before (ibuprofen, naproxen, aspirin, high-dose acetaminophen)

Last step

That's everything.

Thank you for the care you put into this — it genuinely changes how well we can read your results.

Core section: 0% complete

Nothing leaves your device until you tap send.