Which panel are you having performed? *
Thyroid PanelMale Hormone PanelFemale Hormone PanelMetabolic Panel (Glucose/Insulin/Lipids)Comprehensive Panel (Multiple)

Is this your first hormone/thyroid panel, or a repeat test? *
First time having this panelRepeat test (had this before)

If repeat test, what were previous findings?

Rate your overall energy level *

1 = very low energy, 10 = excellent energy

1 – Very low2345 – Moderate678910 – Excellent

Describe your energy pattern through the day *
Consistent through the dayMorning person with afternoon crashSlow to start but improve through dayVariable and unpredictable

Any significant health events in the past 12 months? *
YesNo

If yes, please describe

Heart attack, surgery, diagnosis, hospitalisation, etc.

Any history of thyroid problems?

Personal or family history — both are relevant for interpretation.

Yes – personal historyYes – family historyYes – both personal and familyNo

Have you ever been told you have metabolic syndrome, prediabetes, or diabetes?
YesNoNot sure

List ALL current medications *

Include name, dose, and frequency for each.

List all supplements and vitamins you take

Are you taking any supplements containing biotin? *
YesNoNot sure – I will check my supplements

Current training frequency *
0–1 sessions per week2–3 sessions per week4–5 sessions per week6+ sessions per week

Rate your current stress level *

1 = very low stress, 10 = extremely high stress

1 – Very low2345 – Moderate678910 – Extremely high

How would you describe your recovery status? *
Recovering well between sessionsSometimes feel beaten downConsistently beaten down

What are you hoping to learn from this blood work? *