Before we meet

Your health story,
thoughtfully gathered.

This short intake helps us understand the patterns behind your concerns before your consultation—so our time together can begin with what matters most.

10–12 minDesigned to feel focused

6 sectionsOnly the questions we use

Your paceShort answers are welcome

Your answers are sent to the private Wellness by Andra workspace. Health details are never included in email notifications.

Please complete this once, before your consultation. Short answers are welcome.

Section one

Let’s start with you.

The essentials, without asking you twice.

Full name Email Date of birth Where will you normally be located during consultations? Height optional Current weight optional Has your weight changed meaningfully in the past year?

Section two

What brought you here?

Give us the thread. We’ll explore the details together.

Your three main health concerns, in order of importance

When did your main concern begin? Current impact on daily life

When do you last remember feeling genuinely well—and what was different then? What have you already tried? What clearly helped or made things worse? What would make this consultation feel successful?

Section three

Your health picture.

A concise history helps us prepare safely and intelligently.

Current diagnoses, significant surgeries or hospitalizations Current medications and supplements Medication, food or supplement allergies and serious reactions Important family health history

Oral and dental history

Section four

Food and digestion.

What you actually do matters more than a “perfect” answer.

Walk us through a typical day of eating and drinking

Do you currently follow or avoid a particular diet? How often do you eat breakfast?

Foods that cause noticeable symptoms

Which patterns sound familiar?

Skipping meals Shaky or irritable between meals Sweet cravings Salt cravings Night eating Low appetite Frequent restriction or dieting None of these

Bowel movement frequency Usual stool consistency

Digestive symptoms that occur regularly

Bloating or gas Reflux or burping Nausea or early fullness Abdominal pain Constipation Diarrhea or urgency Incomplete evacuation Greasy or floating stool None

Section five

Your daily rhythm.

Sleep, light, energy, movement and recovery.

Bedtime Wake time Hours slept

Which sleep patterns apply?

Typical daytime energy5 / 10

When is your energy best and worst?

Morning outdoor light Typical sitting time

Current weekly movement or exercise

What happens with exercise?

Pain or limitation Dizziness or palpitations Exercise intolerance Excessive soreness Worse sleep after training I recover well

Final section

Make the plan fit your life.

The best plan is one you can actually use.

Current stress level5 / 10

Largest sources of stress or nervous-system load

Hormonal and reproductive health

Would you like to include this section in your intake?

Readiness to make changes7 / 10

What could make following a plan difficult?

How would you like recommendations presented? Anything important we didn’t ask?

✓

Intake received

Thank you. You’re ready for the next step.

Your answers were sent to the private Wellness by Andra workspace for review before your consultation.

What happens next

We’ll review your health story ahead of your appointment. Your intake reference is being confirmed.

Your health story,thoughtfully gathered.

Let’s start with you.

What brought you here?

Your health picture.

Food and digestion.

Your daily rhythm.

Make the plan fit your life.

Thank you. You’re ready for the next step.

Your health story,
thoughtfully gathered.