Pre-Screen Report

1

Family History* This field is required.We can start with the most basic form of genetic screening, and that's to look at your parents and grandparents. Have any of them been diagnosed with a lifestyle related disease like lung cancer or heart disease? Could you also provide the age of onset? For instance, woman in their mid 30's with a BRCA1/2 variant might be at high risk.

2

Chronic Medication Are you currently taking any prescription or over-the-counter medication? This information can help us determine if you are receiving treatment for any existing conditions. Also mention if you use medicinal herbs/oils for pain or neurological trauma.

3

Other DrugsAre you taking oral contraceptives or been using hormone replacement therapy? If yes, please provide a brand name as well as the duration that you have been on this medication.

4

Iron+ LevelsAre you known to have high or low iron levels? Are you a blood donor or anemic? If yes, please specify.

5

Body Mass Index (BMI)Please provide your details

6

Do you smoke?

YESNO

7

Do you drink?

YESNO

8

Take Aways?Rate your fast food consumption. 1 can be 0 as well if you never eat junk food.

9

Activity LevelsPlease describe your weekly activities. Example: I do strength training 4 days a week, and I jog 2 - 3 miles every other day. I also walk my dog twice a day, and I take the stairs whenever I have the option to.

10

Informed Consent* This field is required.To comply with POPIA and GDPR guidelines for the protection of your identity and personal information, you need to read and agree to the terms and conditions. Please tick the box to provide us with your informed consent to continue.

11

Your Personal EmailTo receive your Wellness Report.

example@example.com

Email Verified

The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification

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12

Please Sign Here:* This field is required.By signing you agree to take full responsibility for the risks involved as stated by the terms of this service.