Lab Intake Form

  • Lab Intake Form

    We need your responses to order labs. Thank you!
  • Date of Birth*
     - -
  • Sex at Birth*
  • Gender Identity*
  • Sexual Orientation*
  • Ethnicity*
  • Race*
  • Do you follow a particular diet?*

  • Let's look at your diet a bit closer now. What foods do you eat, and how ofter?

    If there is a food you eat but wish to exclude from your recommendations, select “Never” — we will not recommend foods marked “Never.”

  • Now, what about beverages? Which ones do you drink, and how often?

  • How often do you eat at restaurants or get take-out?

    This does not include meal subscription services like Blue Apron or HelloFresh

  • Let's shift over to supplements real quick

  • Would you like to receive supplement recommendations?
  • Do you currently take supplements?
  • Do you require NSF Certified for Sport supplements only?
  • Which supplements do you currently take?

  • Now just a few more questions to wrap up.

  • Which exercises do you do on a weekly basis?
  • What is your total daily exposure to the sun?
  • Do you smoke tobacco products?
  • What do you want to focus on?
  • Should be Empty: