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Intake Form

01 — Personal Info

Name

Age

Height / Weight

Phone Number

Email Address

02 — Goals & Expectations

e.g. Build muscle, Lose fat, Recomp, TRT optimization, Bloodwork review, Cycle planning, Peptide guidance, General health, Performance, Gain 10 lbs muscle, lose 10lbs fat, achieve a certain physique, bench 315, side effect mitigation, improving appearance

What are your goals / expectations?

03 — Current Setup

Training

Days per week

Years lifting

Program currently running

Step count / cardio

Nutrition

Estimated calories

Protein

Track food?

Dietary restrictions

Enhancement

Current cycle

Previous cycles

Any future planned cycles

Current / previous supplement & peptide routine

Do you take any ancillary drugs?

Side effects / symptoms currently or previously experienced

Side effects that concern you most / priority to mitigate

Have you experienced / are you prone to hair loss?

04 — Photos & Bloodwork

Having bloodwork uploaded before our first consult isn't necessary but it helps me a ton and guides many of my decisions. Preferably I'd like to see:

Comprehensive Metabolic Panel (CMP)
Lipid Panel (Total Cholesterol, LDL, HDL, Triglycerides)
Total Testosterone
Estradiol (E2) (ultrasensitive preferred if available)
SHBG
Free Testosterone
Thyroid Panel (TSH, Free T4, Free T3)
Cystatin C
Prolactin
ApoB (Apolipoprotein B)

Or if you already have bloodwork on hand and you want to use that I can work with whatever markers you provide.

Upload Bloodwork

Upload Physique Photos

If you prefer, you can also email your files to dillanpsutton@gmail.com along with your name.