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Routine health check
Specific symptoms
Monitoring existing condition
GP recommended
Employer/insurance requirement
Fitness optimisation
Medication monitoring
Other reason
Select all that apply. We can advise which tests are most appropriate based on your symptoms and goals.
Full blood count
Liver function tests
Kidney function tests
Thyroid (TSH)
Iron & ferritin
Vitamin D
B12 & folate
Lipid profile
HbA1c (diabetes screening)
Testosterone
Cortisol
Inflammatory markers (CRP, ESR)
Coeliac screen
Comprehensive metabolic panel
Not sure - want doctor's advice
No
Mild
Moderate
Severe
No weight change
Weight gain (5-10 kg)
Weight gain (>10 kg)
Weight loss (5-10 kg)
Weight loss (>10 kg)
Unintentional weight change
No
Yes - low mood/depression
Yes - anxiety
Yes - brain fog/concentration issues
Yes - other
No
Mild
Moderate
Severe
No
Occasional bloating
Frequent bloating
Diarrhoea
Constipation
Abdominal pain
Multiple issues
No
Mild
Moderate
Severe
No
Yes - minor
Yes - significant
No
Occasional
Frequent (more than monthly)
Select any that apply in your immediate family (parents, siblings)
Type 2 diabetes
Thyroid disease
High cholesterol
Heart disease
Haemochromatosis
Coeliac disease
Anaemia
Other
No family history
No
Yes - not serious
Yes - significant abnormality
Some supplements can affect blood test results
No
Yes - iron or ferritin supplements
Yes - B12 or B vitamins
Yes - vitamin D
Yes - biotin (hair/skin)
Yes - other supplements
Yes - multiple supplements
Some tests require 8-12 hours fasting. We'll advise before your appointment.
No
Yes - understand need to fast
Yes - but have questions
Omnivore (meat and vegetables)
Vegetarian (no meat)
Vegan (no animal products)
Other restricted diet
Sedentary (little to no exercise)
Mildly active (1-2 sessions/week)
Moderately active (3-4 sessions/week)
Very active (5+ sessions/week)
1 unit = 1 glass wine, 1/2 pint beer, 25ml spirit
None
1-4 units
5-14 units
15-21 units
21+ units
Never smoked
Former smoker
Current smoker - occasional
Current smoker - daily
This affects which tests are safe and their interpretation
Not applicable
Not pregnant
Pregnant (weeks?)
Breastfeeding
Regular (every 21-35 days)
Irregular
Heavy periods
Light periods
No periods (menopause or other)
Hormonal contraception can affect some blood results
No
Yes - combined pill
Yes - progestogen-only pill
Yes - implant/IUS/IUD
Yes - injection
Yes - patch/ring
Yes - other
Baseline/preventive health check
Detect underlying condition
Medication safety monitoring
Optimise energy/performance
Weight management support
Fitness/athletic performance
Age-related screening
Other goals
Here's what you've told us. Have a quick check, then hit send - this means your consultation can focus on what actually matters to you.
Your details
Name
Email
Phone
Date of birth
Reason for Testing
What brings you in for blood testing today? -
Tests Requested
Which tests are you interested in? -
Current Symptoms
Are you experiencing fatigue or low energy? -
Have you noticed any recent weight change? -
Have you noticed changes in your mood or mental health? -
Have you experienced hair loss or thinning? -
Are you experiencing any digestive issues? -
Are you experiencing joint pain or muscle aches? -
Have you noticed any skin changes (rashes, eczema, acne)? -
Have you been getting frequent infections (colds, sore throats, UTIs)? -
Medical & Family History
Do you have any existing medical conditions? -
Is there a family history of conditions relevant to blood testing? -
Have you had blood tests before with unusual results? -
Medications & Supplements
What medications are you currently taking? -
Are you taking any supplements? -
Are you aware of fasting requirements for blood tests? -
Lifestyle Factors
What is your current diet? -
How would you describe your exercise level? -
How many units of alcohol do you drink per week? -
Do you currently smoke? -
For Women
Are you pregnant or breastfeeding? -
How would you describe your period pattern? -
Are you on hormonal contraception? -
Your Goals
What are your main health goals or concerns with this testing? -
Is there anything else we should know? -
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