Integrated Wellness Initial Intake
  • This comprehensive intake captures your complete health history to personalize your optimization protocol.

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  • Body Composition Section

    Body Composition Section

    This section gives us a snapshot of how much of your body is made up of fat versus muscle and other tissues, helping us tailor your wellness plan.
  • Medical History

    Medical History

    Your medical history gives us key insights into past conditions, treatments, or surgeries, so we can factor them into your care.
  • Primary Health Goals

    Primary Health Goals

    We ask you to pick your top three health goals—like improving energy, losing weight, or reducing stress—so we can focus on what matters most to you and customize your plan around those priorities.
  • Current Medications and Supplements

    Current Medications and Supplements

    Listing your current medications and supplements helps us avoid interactions and ensure any wellness recommendations are safe and aligned with what you're already taking.
  • Domain Symptom Checklist

    Domain Symptom Checklist

    The symptom checklist allows you to highlight any physical or emotional symptoms you experience. You'll rate each symptom from 0 (none) to 5 (severe), so we can focus on what’s most impactful and track your improvements over time.
  • Metabolic Domain

    Metabolic Domain

    The metabolic domain looks at things like energy levels, appetite, digestion, and other bodily functions that relate to your metabolism, helping us support your body’s balance and overall energy.
  • Inflammatory Domain

    Inflammatory Domain

    The inflammatory domain covers symptoms like aches, swelling, or other signs of inflammation. By understanding these, we can help reduce discomfort and support your body’s recovery.
  • Hormonal Domain

    Hormonal Domain

    The hormonal domain looks at signs that might relate to hormone balance—like mood changes, sleep issues, or menstrual patterns. By spotting these, we can help support your body’s natural rhythms.
  • Thyroid Domain

    Thyroid Domain

    The thyroid domain checks for symptoms that might point to an overactive or underactive thyroid, like changes in energy, weight, or temperature sensitivity, so we can keep your metabolism on track.
  • Adrenal Domain

    Adrenal Domain

    The adrenal domain looks at stress-related symptoms, like fatigue or feeling wired. It helps us understand if your body’s stress response might need some support.
  • Sleep Domain

    Sleep Domain

    The sleep domain focuses on how well you’re resting—like if you’re having trouble falling asleep, staying asleep, or waking up refreshed. It helps us identify ways to improve your sleep quality.
  • Cardiovascular Domain

    Cardiovascular Domain

    The cardiovascular domain focuses on symptoms like heart rate, circulation, or blood pressure concerns, helping us keep your heart health in check.
  • Gut Domain

    Gut Domain

    The gut domain addresses digestion-related symptoms, like bloating, discomfort, or irregularity, so we can support your digestive health and overall wellness.
  • Neurological Domain

    Neurological Domain

    The neurological domain looks at symptoms like headaches, memory issues, or tingling sensations. It helps us understand any nervous system concerns to better support your overall brain and nerve health.
  • Mitochondrial Domain

    Mitochondrial Domain

    The mitochondrial domain focuses on your cellular energy—things like fatigue or stamina. It helps us see if your cells are producing energy effectively, so we can help optimize your vitality.
  • Immune Domain

    Immune Domain

    The immune domain looks at symptoms like frequent illness, allergies, or inflammation. It helps us understand how your immune system is functioning, so we can support it better.
  • Sleep Night-Time Domain

    Sleep Night-Time Domain

    The sleep domain broadly looks at your overall sleep quality—like if you feel rested or have trouble staying asleep. In contrast, the sleep/nighttime domain zeroes in more on nighttime-specific issues—like difficulty falling asleep or waking frequently—so we can target solutions for those nighttime disruptions.
  • Exercise Profile

    Exercise Profile

    The exercise profile gives us a picture of your activity levels, from what types of exercise you do to how often you move. This helps us design a plan that fits your lifestyle and goals.
  • Nutrition Profile

    Nutrition Profile

    The nutrition profile looks at your eating habits—what you eat, how often, and any dietary preferences. It helps us create a plan that aligns with your goals and nutritional needs.
  • Lab Availability

    Lab Availability

    We adhere strictly to HIPAA compliance and prioritize your privacy. While some patients have shared their bloodwork through email, please note that email is not a HIPAA-compliant method of communication. We will always safeguard your information to the highest possible standards. Ultimately, it is your choice if you wish to submit protected health information in this way, and we’re happy to discuss secure alternatives if preferred.
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