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Pre-consultation form

Supplements

A few questions about what you're currently taking and what you're looking for. This is optional, but it helps your doctor prepare evidence-based recommendations rather than guessing. Takes about 3 minutes.

~8 minutes 4 short sections Confidential
Just getting started 0 of 4 sections

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

Supplements

What are you looking for from a supplement consultation? -

True

Current Supplements -
List all supplements, vitamins, and herbs you're currently taking (include brand, dose, frequency) -
How long have you been taking your current supplements? -
Have you noticed any benefits from your current supplements? -
Have you experienced any side effects from supplements? -
Diet & Nutrition -
Primary diet type -
Dietary restrictions or allergies -
Do you have any conditions affecting nutrient absorption? -
Blood Tests & Deficiencies -
Have you had recent blood tests checking for deficiencies? -
Current Medications & Health -
List all current medications (important for drug-supplement interactions) -
Are you pregnant or breastfeeding? -
Exercise level -
What are your specific supplement goals? -
Anything else we should know about your nutritional needs? -
Blood test results showing nutrient levels, or a copy of any previous supplement recommendations.
Your information is sent securely to your doctor at LoveMyLife. We will not share your details with third parties. By submitting this form, you consent to LoveMyLife contacting you regarding your appointment.