HumanForm Wellness
CLIENT INTAKE — PERFORMANCE PROFILE
To build a clear, structured plan for your health and performance.
1. Basic Information
2. Primary Goal (Check 1–2)
3. Current State (Quick Snapshot)
Nutrition:
Stress Level:
4. Experience (Check all that apply)
5. Biggest Challenge
6. Top 3 Goals
1
2
3
7. Health Flags (Check all that apply)
Coach Notes
Strengths
Constraints
Focus
8. Hormone Health (Select your biological sex to see relevant questions)
Biological Sex
Your answers help us personalize your hormone and performance protocol.
Menstrual Cycle
Cycle status:
Cycle symptoms:
Reproductive History
Currently pregnant or breastfeeding?
Perimenopause / Menopause?
Diagnosed conditions:
Medications & Hormones
Birth control?
Hormone therapy (HRT/BHRT)?
Current Symptoms
Low Testosterone Symptoms
Clinical Indicators
Morning erections (testosterone marker)?
Testicular health concerns?
PSA / prostate concerns?
Medications & Hormones
Currently on TRT?
Past TRT or hormone use?
Using peptides or SARMs?
Recent Lab Work
Testosterone panel tested?
Known results:
Shared — All Clients
Energy fluctuations tied to time of day or cycle?
Mood / mental clarity fluctuations?
Additional hormone-related concerns (check all that apply):
— Next Step: Build Your HumanForm Plan —
Isham will review your form and reach out within 24 hours.