1 - No-Cost Health Risk Assessment

We appreciate your interest in receiving care at Insyte.

Your well-being is important to us, and we're here to support you. To ensure you receive the best care possible, kindly answer a few questions that will help us identify any potential health risks and tailor our preventive and diagnostic screenings to your specific needs.

Are you a current or former user of tobacco products? (Cigarettes, cigars, vape, etc)*

YesNo

How often do you or did you use tobacco products?*

DailyFrequentlyOcassionally

Are you vaccinated against Covid-19?*

YesNo

Did you get vaccinated against the Flu in 2022?*

YesNo

Do any of your family members and relatives have or had any kind of cancer?*

I am unsure about my family history of cancerYesNo, all my family members and relatives have never had cancer

Are you experiencing any unexplained weight loss?*

YesNoI don't know

Are you experiencing abdominal or rectal pain?*

YesNoI don't know

Are you experiencing difficulty or are in pain while urinating?*

YesNoI don't know

Do you have lower back pain on either side of the body?*

YesNoI don't know

Have you had more than one sexual partner or have engaged with unprotected sex in the past year?*

YesNoI don't know

Have you ever had a sexually transmitted infection (STI) such as syphilis, chlamydia, gonorrhea, herpes, or genital warts*

YesNoI don't know

Are you experiencing any of these symptoms?*

How about these symptoms?*

My hair / skin / nails are brittle, rough, or coarseI have puffiness around the eyes, face, hands, or feetI feel depressed, restless, moody, sadI have difficulty concentrating or remembering thingsI feel fatigued or exhausted more than normalI'm not experiencing any of these symptoms

By signing below, you agree to all terms and conditions set forth by Insyte Biomed, LLC, particularly but not limited to, the company's policies on HIPAA, the No Surprises Act, Returns and Exchanges, and Privacy.

Signature*

I would like to subscribe to the communications, educational materials, and other promotions of Insyte Biomed and its affiliates*

YESNO

No-Cost Health Risk Assessment

how can we help you?

NO-COST Health Risks Assessment

Let's answer a few questions about your health:

Consent