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Poppy Health New Client Intake

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    We use your state to confirm availability and match you with a licensed practitioner.
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    Let's continue.

    What happens next:

    This is a paid telehealth service—not an automated result or quiz

    Your responses will be reviewed by a U.S.-based practitioner, licensed in your state, practicing Traditional Chinese Medicine (TCM).

    The $99 includes your initial asynchronous telehealth visit and 3 months of care:

    • Practitioner review of your intake to assess your symptoms and health history
    • Safety screening (including medications, supplements, and potential interactions)
    • A personalized diagnosis and care plan, which may include targeted lifestyle and dietary guidance
    • Ongoing support and adjustments as your condition evolves

    This clinical review is required before any individualized plan or formula is created.

    If appropriate, your practitioner may recommend a custom herbal formula. Clinical-grade herbal formulas are not included in the $99 and are purchased separately after your plan is created, with pricing shared before anything is dispensed.

    Care is delivered remotely through secure messaging and clinical review. Checkout for the service happens at the end of the questionnaire.

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    ⏱️ This intake takes about 10 minutes.

    For the best experience, complete it in one sitting, as progress may not be saved if you leave the page. On desktop, you can use “Save & Continue Later.”

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    Pick a Date
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    Please confirm if you are completing this on behalf of a minor.
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    We ask for your biological sex because it can influence which herbal options may be most appropriate for you.
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    Please enter your full legal name. This helps us maintain accurate health records and properly document your care.
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    Your email is required for secure communications about your care.
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    Now let’s take a closer look at your symptoms.

    We'll start with your appetite and thirst.

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    This might look like skipping meals, forgetting to eat, or not feeling hungry even when you haven’t eaten in a while.
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    (Please choose one)
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    This refers to a strong, persistent appetite that feels excessive, not just healthy hunger.
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    This means you rarely feel thirsty, even when you haven’t had much to drink
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    Thanks, let's check in on your energy

    These questions help us get a feel for your usual energy—whether it's steady, low, or somewhere in between.

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    This includes feeling wiped out after activity, or just tired most of the time.
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    This includes ongoing mental, emotional, or situational stress.
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    Thank you. Let’s check how your body responds to cold.

    These small signs help us better understand your overall energy.

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    This means your skin may feel cold to the touch or you may feel cold inside, even when others feel comfortable. (Please choose one)
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    This may feel like sudden chilliness, clamminess, or unexpected sweating while at rest, especially on the chest, back, or limbs. (Please choose one)
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    This could feel like water retention, heaviness, or soft swelling under the skin. (Please choose one)
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    Thanks—let's keep going

    Now we'll move into a few questions about your digestion. Just let us know what applies to you.

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    (Select all that apply—these help us understand how your upper digestion feels after eating)
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    Hint: Indigestion feels like your food sits heavily, digests slowly, or causes discomfort in your upper stomach.
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    Hint: This is different from slow digestion. It feels more like pressure or blockage under your ribs.
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    This means feel bloated, full, or swollen in your lower or entire belly—especially after eating or when you're feeling stressed.
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    You're doing great.

    Just a couple more questions to wrap up this section.

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    This may include gas that’s loud, difficult to pass, foul-smelling, or causes pressure in your lower abdomen.
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    (Please choose one)
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    (Select all that apply)
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    (Please choose one)
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    Let's shift focus to your sides

    Tension or soreness around the ribs can be a helpful clue.

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    This may feel like aching, pressure, or tension along one or both sides of your torso. It can come and go, and may get worse with stress, meals, or emotional shifts. (Please choose one)
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    Thanks—that gave us a helpful picture.

    Now we'll focus on your upper digestion—things like burping, reflux, or pressure. These can be subtle, but they say a lot.

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    (Please choose one)
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    (Select all that apply)
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    Thanks for sticking with us.

    You've given us valuable clues we can work with.

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    Next up. Your lower digestion.

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    This feels like a vague sense of unease, tightness, or something not sitting quite right.
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    Sometimes this feels like tightness, tension, or just a sense that something’s off in your lower belly — even if it’s not painful. Does that sound familiar?
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    This can feel like pressure, weight, or something weighing you down inside.
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    It might feel like your belly is weighed down, bloated, or slow to move—especially after eating. Have you noticed that?
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    This may feel like a stabbing, burning, or tight sensation that comes and goes.
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    Almost done with lower digestion.

    These next questions focus on sensations like pressure, urgency, or irritation.

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    This means a persistent urge or pressure like you need to go — even when your bowels are empty.
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    This might feel like pressure, a sense that you haven’t fully emptied, or repeated urges throughout the day. Does that sound familiar?
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    This may feel like heat, stinging, or soreness during or after a bowel movement.
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    Now let's talk about stool.

    Your digestion tells us a lot, and stool is an important part of the story.

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    (Select the option that best describes your usual experience)
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    (Select the option that best describes your usual experience)
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    This includes frequent urges to go, even if your stools aren’t loose or watery.
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    This is infrequent, hard, or difficult bowel movements. Your stool may be dry, and passing it may feel slow or strained.
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    Thank you. Let's shift gears a bit

    We’ve covered constipation—now we’ll look at things like urgency, looseness, and irregularity to complete the picture.

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    This is stools that are soft, unformed, or break apart easily.
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    You're doing great.

    Let's keep going.

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    Let’s take a closer look at your stool’s appearance

    We know—it’s not dinner conversation. But stool offers valuable insight into how your digestion’s really working.

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    This may feel like your body “clears out” first thing, even if you haven’t eaten yet.
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    This means a noticeably sour, foul, or unusual smell—especially if it's different from your normal.
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    It may appear yellowish, sticky, or jelly-like.
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    This might look like red streaks, clots, or darker discoloration.
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    Some people experience both constipation & loose stools

    Let’s check for alternating patterns.

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    This might mean you swing between hard, dry stools and loose or urgent ones — or just feel like you don’t have a consistent pattern.
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    Let’s take a closer look at your lower abdomen

    Feelings of heaviness or pressure here can be an important clue.

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    Your gut has a lot to say.

    Your answers are helping us complete the picture.

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    Next up. Oral health.

    Taste, breath, or gum changes can offer clues about digestion. Just answer what feels relevant.

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    This refers to a sour or acidic taste that lingers in your mouth — not just from eating certain foods, but often when digestion feels off or after reflux.
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    This means a lingering bitter or metallic taste on your tongue—not just after certain foods, but often throughout the day or in the mornings. It may be more noticeable when digestion feels off.
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    You may produce more saliva than usual, feel the need to swallow often, or notice occasional drooling.
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    Next up. Reproductive & Pelvic Health.

    These next questions might seem unrelated—but they matter. The body’s all connected, and this helps us see the full picture (not just the gut stuff).

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    This refers to discharge from the genital area that’s unusual for you or not part of your normal function.
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    This refers to symptoms like irritation, burning, or soreness in the groin or genital region.
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    Final question on symptoms.

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    This might include your skin looking unusually yellow or sallow, or the whites of your eyes appearing slightly yellow, especially during times of illness or digestive upset.
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    Thanks for walking through your symptoms.

    Next, tell us what you’d most like to improve.

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    Tell us what you’d most like to improve—like feeling more regular, reducing bloating, or enjoying meals without discomfort.
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    Note any related procedures or hospitalizations (approximate dates are fine).
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    Let's make sure your formula is safe

    A few quick questions about medications, allergies, and other factors.

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    Some herbs may need to be adjusted during these times.
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    Knowing your weight helps us calculate the most effective and safe dosage.
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    This helps us avoid any interactions and tailor your formula safely.
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    This helps us make sure your formula is safe for you.
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    Your formula can be prepared in two formats. Both deliver the same therapeutic effect—this is simply about what fits best into your routine.
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    Final step

    Add two photos of your tongue

    • Top of tongue
    • Underneath of tongue

    These help your practitioner personalize your herbal formula.

    Tips for the best photo

    • Use natural light (near a window is best)
    • Selfie mode is okay
    • Keep your full tongue visible and in focus
    • Take the photo right after sticking your tongue out

    Avoid when possible

    • Camera flash
    • Colored lighting
    • Filters or edited photos

    Example photos

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    This can be about your health, symptoms, or anything else that feels relevant (optional).
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