Patient screening questionnaires

Start with the right questions.

Choose the short questionnaire that matches your goal. We collect the essentials first so you can get started quickly; your clinician can gather additional details during care when they are relevant.

Questionnaire 1 · Tier 2 and Tier 3

Men’s Vitality & Endocrine Screening

An ADAM-informed symptom and safety screening to help the clinical team understand vitality, hormonal-health concerns, fertility goals, and baseline risk factors.

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Questionnaire 2 · Tier 1 and Tier 3

Brief Weight-Loss Questionnaire

A brief first step covering the essential information your clinician will review before a weight-loss visit. Your clinician will gather the complete history with you during care.

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Questionnaire 3 · Tier 1 and Tier 3

Functional Gut & Cellular Health Intake

A short digestive, lifestyle, recovery, and health-history intake that organizes your symptoms and goals for personal clinician review.

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Universal medication review · Required for all programs

Medication & Contraindication Review

A structured medication-reconciliation questionnaire that gives the clinical team the details needed to review allergies, interactions, duplicate therapy, and potential contraindications.

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