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Health Testing
questionnaire

Health Testing Questionnaire

Discover which health tests are right for you.

By completing this questionnaire, we can recommend health tests tailored to your needs.

Full name*

Age*

Phone*

Email*

Sex assigned at birth*

Height*

Weight*

What are your primary health goals?*

Gain a better understanding of my body and genetics

Increase energy levels

Weight issues

Improve digestion

Enhance immune function

Address specific health conditions (e.g., hormonal imbalance, inflammation)

Other (please specify):

Do you currently have any specific health concerns or symptoms? (Select all that apply):*

Bloating

Constipation

Loose stools

Irritable Bowel Syndrome (IBS)

Acne

Eczema

Dry skin

Chronic fatigue

Low energy

Hair loss

Anxiety

Low mood

Depression

Joint pain

Muscle pain/cramps

Weight gain

Weight loss

Menopause

Menstrual cycle irregularities

Improve immunity

High blood pressure

High cholesterol

Diabetes

Prediabetes

Disturbed sleep

Migraines

Other (please specify):

Please provide details of your medical history, including any health conditions and past surgeries*

Are you currently taking any supplements or medications? If yes please state names, doses, regularity*

Which health tests are you interested in? Select all that apply*

Hormone testing

Gut health - microbiome analysis

Oral health - microbiome analysis

Vaginal health - microbiome analysis

Nutrient deficiencies - vitamins and minerals

Food sensitivity testing

Cardiovascular bloods

Inflammatory markers

Blood sugar/insulin testing

DNA methylation testing

Other DNA testing (e.g., detoxification, metabolism, nervous system)

General wellness

Other (please specify):

How would you describe your diet? (e.g., balanced, high protein, vegetarian, etc.) *

Please describe your activity levels (e.g., sedentary, moderate, active) and your daily activities*

Please describe your stress levels (e.g., low, moderate, high) and what typically causes your stress*

What are your top priorities when choosing health tests? - Cost - Accuracy of results - Comprehensive insights - Ease of the testing process - Time to receive results. Feel free to add any other factors that are important to you!*

Is there any additional information that would help us tailor recommendations for your health testing needs?

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