Body Sings System Assessment

Body Sings System Assessment

A system-based intake to triage your current state into the right optimization tier.
Client Baseline
Client Name*

First NameLast Name
Email*
example@example.com
Age*
Gender*
Height*
Weight*
Primary Concern*
Neurological Assessment

Neurological Symptoms Rating*

Rows	0	1	2	3	4	5
Anxiety
Brain fog
Focus
Sleep
Irritability

Anxiety severity*

0

1

2

3

4

5

0 is None, 5 is Severe
Brain fog severity*

0

1

2

3

4

5

0 is None, 5 is Severe
Focus severity*

0

1

2

3

4

5

0 is None, 5 is Severe
Irritability severity*

0

1

2

3

4

5

0 is None, 5 is Severe
Metabolic Assessment

Metabolic Assessment Scale*

Rows	0	1	2	3	4	5
Fatigue
Digestion
Weight
Cravings
Crashes

Fatigue*

0

1

2

3

4

5

0 is No issue, 5 is Severe
Digestion*

0

1

2

3

4

5

0 is No issue, 5 is Severe
Cravings*

0

1

2

3

4

5

0 is No issue, 5 is Severe
Metabolic Score
Endocrine/Aging Assessment
Libido*
Hormones*
Fatigue*
Hair*
Skin*
Aesthetic Markers
Skin dryness*

0

1

2

3

4

5

0 is None, 5 is Severe
Dark circles*

0

1

2

3

4

5

0 is None, 5 is Severe
Nails*

0

1

2

3

4

5

0 is Poor, 5 is Excellent
Puffiness*

0

1

2

3

4

5

0 is None, 5 is Severe
Recovery*

0

1

2

3

4

5

0 is Poor, 5 is Excellent
Stress Load
Stress*

0

1

2

3

4

5

0 is Low, 5 is High
Recovery*

0

1

2

3

4

5

0 is Low, 5 is High
Burnout*

0

1

2

3

4

5

0 is Low, 5 is High
Exhaustion*

0

1

2

3

4

5

0 is Low, 5 is High
Sleep Analysis

Sleep quality assessment*

Rows	0	1	2	3	4	5
Falling asleep
Waking
Unrefreshed
Irregularity

Falling asleep
Waking
Unrefreshed
Health Background
Current health conditions*
Current medications
Current supplements
Commitment and Priority
YesNoMaybe
Fast-trackStandard
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