Finlandia — Advanced Health Assessment

👤 Your details

Last name

First name

Mobile phone

City

Sex / gender identity

🍽️ How meals work in your life

Which best describes how your meals are decided and prepared?

I choose & prepare nearly all my meals Most meals, prep shared Someone else prepares most Rely on restaurants/delivery/prepared My schedule makes meal planning difficult Other

🩺 Body systems — quick screen

For each system, answer the one Yes/No question. If you answer Yes, a short detail section opens.

📎 Documents (all optional)

You don't need any of these to submit. Check what you'll bring to your consultation, and upload now only if it's convenient.

🥗 Very last — Food

If you'd like, jot down what you typically eat over a few days. Totally optional — even a rough note helps.

🔬 Questions for our team

Questions you'd like the medical team to specifically research for you

📝 Terms & Informed Consent

Electronic signature — print full name

Date