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Beyond Standard™ Labs
by Conceive Wellness Your health data belongs to you. You deserve to understand it.
STEP 1: complete this brief form
STEP 2: follow the secure Fullscript link to purchase your lab panel
STEP 3: after purchasing your labs, you’ll be guided to book your blood draw with Quest Diagnostics
STEP 4: you will receive your personalized written review of your results
Please note: Results take approximately one week. If you'd like to talk through your results, you can book an optional virtual consultation after receiving your results. This service is only available while you are physically located in California. It is provided within the scope of California chiropractic care and does not replace care from your primary doctor or other medical providers when needed.
Full legal name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Location
Please confirm your physical location
I confirm that I am physically located in California while receiving this service. I understand that I must be physically located in California when my personalized report and recommendations are reviewed and delivered.
*
Please Select
YES, I confirm.
I agree to notify Conceive Wellness if I leave California before receiving my report.
Reproductive and hormonal status
Please select all that currently apply:
Trying to conceive
Undergoing fertility treatment or taking fertility medications
Pregnant
Postpartum
Breastfeeding
Weaning
Perimenopause
Menopause
Other
If pregnant, how many weeks?
If postpartum, how many months or years?
Medical and supplement reactions
Please list any medication or supplement allergies, sensitivities, or previous adverse reactions. Write “none” if applicable.
*
Medical History
Please select any that apply:
*
current health condition
recent surgery
pregnancy complication
current cancer treatment
condition being monitored by a specialist
none
Please describe, including the approximate onset date and current status:
*
Required Checkboxes
*
I consent to receiving services through asynchronous telehealth, including electronic intake, professional review of my health information and laboratory results, and electronic delivery of my personalized report and recommendations. I understand that a live appointment is not automatically included.
I understand that electronic communications may occasionally be delayed, interrupted, or subject to privacy and security risks despite reasonable safeguards.
I understand that Dr. Jenny Stofer will personally review my laboratory results and the Fullscript-generated wellness plan before it is released. Fullscript may use technology, including AI-assisted tools, to generate portions of the report.
I understand that this service provides nutritional and wellness guidance within Dr. Jenny’s chiropractic scope and does not replace primary medical care, emergency care, or treatment from an appropriate medical provider.
I understand that additional information, a live consultation, repeat testing, or referral to another healthcare provider may be required before recommendations can safely be provided. I agree to seek appropriate medical follow-up for abnormal or urgent findings.
I agree to provide complete and accurate information through Jotform and Fullscript, including my current medications and supplements, and to notify Conceive Wellness of any changes to my health, reproductive status, or physical location before my report is delivered.
I understand that urgent symptoms should not be submitted through this service. If I am experiencing a medical emergency, I will call 911 or seek immediate medical care.
Please verify that you are human
*
By signing below, I confirm that I have reviewed, understood and agreed to all acknowledgments above.
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit your intake to continue to the secure lab platform and choose your lab panel.
Please review your answers before submitting. Once submitted, your intake cannot be edited.
Submit & Choose Labs
Submit & Choose Labs
Should be Empty: