Pre Bloods Questionnaire

Please complete this form BEFORE your blood test. This information is essential for accurate hormone analysis and will help us provide personalised recommendations. Completion time: 5-7 minutes.

SECTION 1: ESSENTIAL INFORMATION

Full Name *

Age *

Date of Birth *

Email *

Phone Number

Are you currently using Testosterone Replacement Therapy (TRT) or any form of testosterone? *
Yes - Currently on TRTYes - Recently stopped TRTNo - Natural production only

SECTION 2: TRT PROTOCOL DETAILS

📋 IMPORTANT - Blood Test Timing for TRT Users:

If you're on TRT, please schedule your blood test for the morning you're due to inject, BEFORE you inject. This gives us your "trough" reading - the most informative measurement for protocol optimisation.

Example: If you inject Monday & Thursday mornings, book your blood test for Monday or Thursday morning, and inject AFTER the blood draw.

Type of Testosterone *
Not applicable - not on TRTTestosterone CypionateTestosterone EnanthateTestosterone PropionateTestosterone Sustanon (blend)Testosterone UndecanoateDon't knowOther

If other, please specify:

Total Weekly Dose (mg) *

Injection Frequency *
Not applicableDailyEvery other day (EOD)Twice weeklyOnce weeklyEvery 10-14 days

Source of Testosterone *
Not applicable - not on TRTNHS prescriptionPrivate UK clinic (pharmaceutical grade)Online clinic (pharmaceutical grade)Underground laboratory / non-pharmaceuticalOther

Are you using any additional TRT-related medications?
HCG (Human Chorionic Gonadotropin)Aromatase Inhibitor (Arimidex, Aromasin, Letrozole)NoneOther

If other, please specify:

If you RECENTLY STOPPED TRT - when did you stop?

Blood Test Timing Confirmation *
I've scheduled my test for the morning BEFORE my next injection (trough timing)I've already had my blood test takenI need help scheduling my test appropriatelyNot applicable - I'm not on TRT

SECTION 3: MEDICATIONS & SUPPLEMENTS

Are you currently taking ANY of the following medications? *
Blood pressure medicationAntidepressants (SSRIs, SNRIs)AntipsychoticsOpioid pain medicationCorticosteroids (prednisone, etc.)Statins (cholesterol medication)Finasteride (Propecia) or DutasterideThyroid medicationDiabetes medicationNone of the above

If yes to any medication above, please list names & dosages:

Current Supplements (select all that apply)
Vitamin DMagnesiumZincBoronVitamin B6Omega-3 / Fish OilAshwagandhaSaw PalmettoNettle RootTribulus or testosterone boostersNone

Vitamin D Dose (IU per day)

Zinc Dose (mg per day)

Magnesium Dose (mg per day)

SECTION 4: BLOOD TEST PREPARATION

💧 CRITICAL - Hydration Protocol:

To ensure accurate results, please drink 2-3 litres of water the day before your blood test, and 500ml upon waking on test day. Dehydration artificially elevates ALL hormone values by 10-15%, making results misleading.

Will you be fasted for your blood test? *
Yes - I will fast 4+ hours (water only)Yes - I will fast 8+ hours (water only)No - I will eat before the testAlready tested - I was fastedAlready tested - I was not fasted

Hydration Commitment *
I commit to following the hydration protocol (2-3L previous day, 500ml upon waking)I have already taken my blood test and was well-hydratedI have already taken my blood test and may have been dehydrated

Training proximity to blood test *
No training within 24 hours of testLight training 12-24 hours beforeModerate training 12-24 hours beforeIntense training 12-24 hours beforeTrained within 12 hours of testAlready tested - no training 24hrs priorAlready tested - trained close to test time

SECTION 5: SYMPTOMS & GOALS

What are your primary goals for this hormone test? *
General health baselineInvestigating symptoms (energy, mood, libido)Athletic performance optimisationMuscle building / body recompositionWeight loss / fat lossTRT monitoring / protocol optimisationPost-TRT recovery assessmentOther

Are you experiencing any of the following symptoms?
Low energy / chronic fatigueDifficulty concentrating / brain fogReduced libido / sex driveErectile dysfunction or quality issuesDifficulty building muscle despite trainingDifficulty losing fat despite dietMood changes (irritability, low mood, anxiety)Poor recovery from trainingSleep issues (difficulty falling asleep, frequent waking)None - feeling good

If you ARE experiencing symptoms, how would you rate the overall impact on your quality of life? *
Minimal - minor inconvenienceModerate - affecting some daily activitiesSignificant - substantially impacting daily lifeSevere - debilitating impactNot applicable - no significant symptoms

SECTION 6: LIFESTYLE FACTORS

Average Sleep Per Night *
Less than 5 hours5-6 hours6-7 hours7-8 hours8+ hours

Sleep Quality *
Excellent (wake refreshed)Good (mostly sleep through)Poor (frequent waking)Very poor (insomnia)

Current Stress Level *
Low (generally relaxed, manageable demands)Moderate (some pressure but coping)High (significant stress affecting function)Very high (overwhelming stress)

Training Frequency *
Not currently training1-2 sessions per week3-4 sessions per week5-6 sessions per week7+ sessions per week

Primary Training Type
Resistance training / weightliftingEndurance (running, cycling, swimming)CrossFitHYROXTeam sportsMartial arts / MMARecreational / general fitnessNot currently training

Alcohol Consumption *
None - abstain completelyOccasional (1-2 drinks per month)Light (1-3 drinks per week)Moderate (4-7 drinks per week)Moderate-heavy (8-14 drinks per week)Heavy (15+ drinks per week)

SECTION 7: BODY COMPOSITION & METABOLIC HEALTH

Height (cm)

Weight (kg)

Waist Circumference (cm)

Body Fat % (if known)

Have you had RMR + mBCA testing with Theorem Metabolic?
Yes - within last 6 monthsYes - more than 6 months agoNo - interested in bookingNo - not interested currently

If yes, most recent visceral fat volume (litres):

Dietary Approach *
Balanced omnivoreHigh protein / athlete-focusedLow carbohydrate / ketoVegetarianVeganIntermittent fastingCaloric restriction (<1500 kcal/day)Don't track / intuitive eating

SECTION 8: MEDICAL & HORMONE HISTORY

Have you been diagnosed with any of the following?
Hypogonadism (low testosterone diagnosis)Thyroid disorderDiabetes or pre-diabetesHigh blood pressureHigh cholesterolSleep apnoeaDepression or anxiety disorderNone of the above

Previous Anabolic Steroid Use (CONFIDENTIAL - Critical for Interpretation) *
Never usedYes - once or briefly (<3 months total)Yes - short-term (3-12 months total)Yes - long-term (1+ years total)Prefer not to say

If yes to steroid use - how long ago did you stop?

Have you had hormone testing before?
No - this is my firstYes - with Theorem MetabolicYes - with NHS or other provider

If yes - most recent testosterone result (if known):

SECTION 9: ADDITIONAL INFORMATION

Is there anything specific you'd like us to focus on in your analysis?

Recent life changes or relevant context (optional)

SECTION 10: DATA CONSENT

We are collecting sensitive personal health data, including hormone results and health information. This data will be used solely for creating your personalised hormone analysis and will be handled with strict confidentiality in accordance with UK GDPR and our privacy policy.

Data Consent & Acknowledgements *
I confirm the information provided is accurate to the best of my knowledgeI consent to Theorem Metabolic collecting and processing my health data for personalised hormone analysisI understand this analysis provides coaching, insights, and education - NOT medical diagnosis or treatmentI acknowledge I should consult my GP or qualified medical professional for medical decisionsI consent to Theorem Metabolic storing this data securely per UK GDPR

Marketing Consent (Optional)
I consent to receiving educational content and service updates from Theorem Metabolic via email