Section 1 of 6

Personal Details

Let us know the basics so we can prepare for your consultation and send you the right lab instructions for your country.

Your Consultation

—

First Name *

Last Name *

Email Address *

Phone Number * (inc. country code)

Date of Birth *

Biological Sex

Country of Residence *

Height

Weight

Occupation (optional)

Referral Code (if you have one)

All fields marked * are required

Section 2 of 6

Health Goals

What are you hoping to achieve? Select everything that applies — this shapes the entire protocol.

Primary goals (select all that apply)

Longevity & Healthspan

Slowing biological ageing, extending quality years

Body Composition

Fat loss, muscle gain, body recomposition

Athletic Performance

Strength, endurance, power output

Recovery & Tissue Repair

Injury recovery, joint health, faster recuperation

Cognitive Function

Mental clarity, focus, memory, neuroprotection

Hormonal Optimisation

Testosterone, GH, thyroid, adrenal balance

Sleep Quality

Deep sleep, recovery, circadian regulation

Energy & Vitality

Fatigue, mitochondrial function, daily drive

Sexual Health & Libido

Drive, function, reproductive health

Immune & Gut Health

Immunity, inflammation, digestive health

Skin & Aesthetics

Collagen, skin repair, anti-ageing appearance

In your own words — what's your single most important goal?

Section 3 of 6

Current Health

Help us understand your baseline. All information is confidential and used only to prepare your consultation.

How would you rate your overall health right now?

Overall health 5

PoorExcellent

Energy levels 5

Very lowVery high

Stress levels 5

MinimalVery high

Do you have any diagnosed medical conditions?

No diagnosed conditions

Generally healthy, no chronic conditions

Yes — managed conditions

I'll provide details below

Conditions / diagnoses (if any)

Current medications or supplements

Any known allergies or adverse reactions?

Family history (optional but helpful)

Cardiovascular disease

Type 2 diabetes

Cancer (any type)

Neurological conditions

None / not known

Section 4 of 6

Lifestyle

Your daily habits directly influence your biomarkers and what protocols will work best for you.

Sleep

Average hours per night

Sleep quality

Exercise & activity

Sedentary

Little to no regular exercise

Moderate

2–3× per week

Active

4–5× per week

Very Active

Daily training

Athlete

Competitive / elite level

Primary type of training

Resistance / weight training

Cardiovascular / endurance

HIIT / CrossFit

Yoga / mobility / flexibility

Sport-specific (e.g. football, cycling, martial arts)

Nutrition & diet

Omnivore

No restrictions

Carnivore / Keto

High fat, low carb

Vegetarian / Vegan

Plant-based

Intermittent Fasting

Time-restricted eating

Alcohol consumption

Smoking / tobacco

Section 5 of 6

Peptide Experience

Honest answers here help us pitch the consultation at the right level — whether you're completely new or deeply experienced.

Overall experience with peptides

Completely New

Never used peptides, want to learn from scratch

Beginner

Some research done, possibly tried 1–2 compounds

Intermediate

Used several peptides, familiar with protocols

Experienced

Multiple years of use, looking to optimise further

Compounds you have previously used (select all that apply)

BPC-157

Gut health, tissue repair, joint recovery

TB-500 / Thymosin Beta-4

Injury recovery, inflammation, tissue regeneration

Ipamorelin / CJC-1295

GH secretagogues, body composition, recovery

Sermorelin

GH releasing hormone analogue

PT-141 / Bremelanotide

Sexual function, libido

Selank / Semax

Cognitive, anxiety, nootropic

Epithalon

Longevity, telomere, anti-ageing

GHK-Cu (Copper Peptide)

Skin, hair, wound healing

None — completely new

Any adverse reactions to previous compounds? (optional)

What are you hoping the consultation will give you that you haven't been able to figure out yourself?

Where are you in your hormonal journey?

Regular cycle

No major changes yet, but want to optimise

Perimenopause

Cycle changes, symptoms appearing, still menstruating

Menopause

No period for 12+ months

Postmenopause

Several years past last period

Surgical / Medical menopause

Following surgery or treatment

Not sure

That's okay — we'll figure it out together

Symptoms you're currently experiencing (select all that apply)

Hot flashes / night sweats

Vasomotor symptoms

Sleep disruption

Difficulty falling/staying asleep, early waking

Mood changes

Anxiety, low mood, irritability, mood swings

Brain fog / memory

Difficulty concentrating, word-finding issues

Weight changes

Particularly around midsection, harder to lose

Fatigue / low energy

Persistent tiredness even after sleep

Joint / muscle pain

Aches, stiffness, reduced flexibility

Libido changes

Reduced desire, dryness, discomfort

Skin / hair changes

Dryness, thinning hair, skin texture changes

Heart palpitations

Awareness of heartbeat, racing heart

Digestive changes

Bloating, IBS-like symptoms

None of the above yet

Just exploring & being proactive

How long have you been experiencing symptoms?

Less than 6 months

6 months – 2 years

2 – 5 years

5+ years

HRT (Hormone Replacement Therapy) status

Currently on HRT

Want to optimise or review

Tried HRT in the past

Stopped — want to discuss alternatives

Considering HRT

Want guidance before deciding

Not interested in HRT

Looking for natural & lifestyle approaches

If on HRT, please share details (type, dosage, how long) — optional

Previous treatments or approaches you've tried (optional)

Family history — your mother's / sister's menopause experience (optional)

What would make this consultation a success for you?

Section 6 of 6

Blood Tests & Consent

Almost done. Let us know about your blood test status and confirm your consent to proceed.

Do you have existing blood test results?

Yes — recent (within 3 months)

I can upload or share these

Yes — older than 3 months

May need a fresh panel

No — need to get tested

We'll send you lab instructions

Not sure what I have

We'll guide you

If you have results — what was tested? (optional)

Anything else you want us to know before the consultation?

Consent & confirmation

I confirm I am 18 years of age or older

I understand this is a wellness consultation, not a clinical diagnosis or medical treatment

Recommendations are wellness guidance provided by an EU-licensed physician

I confirm my information is accurate to the best of my knowledge

I agree to the HealthHub Clinic privacy policy and terms of service

✓

You're all set.

Your consultation slot is reserved and your intake questionnaire has been received. A confirmation email with everything you need is on its way.

Done — Slot reserved ✓ Your consultation time is booked. You'll receive a calendar invite by email.

Done — Intake questionnaire ✓ Your responses are saved. Our team will review them before your session.

Next — Blood test instructions We'll email you lab instructions for your country so you're ready for the consultation.

Questions? Email clinic@healthhub.one