AIFH Client Intake

Step 1 of 15

Welcome — Let's Start With Honesty

Two consents before we begin. These protect you and make sure we're on the same page about what this work is.

This isn't a form to fill out. It's a full picture of you — so I can find the root cause, not just the symptom. Truth, logic, and science. Be honest. That's the only way this works.

Step 2 of 15

Contact & Basics

Standard intake info. If you came from a direct link, some of this may already be filled in.

First name *

Last name *

Date of birth *

Sex at birth *

Email *

Phone *

City *

State *

Zip *

Height *

Weight *

Emergency contact *

Step 3 of 15

What Brought You Here

Your biggest health problem. Don't soften it. Don't pre-filter. Tell us what's actually going on.

Primary health concern *

How long have you dealt with it? *

Severity (1-10) *

If under 8, why aren't you at 10? Conditional

What have you tried so far? *

What worked?

What failed?

Doctor visits (last 2 yrs)

Symptoms told to doctor

How many did they investigate vs. prescribe-and-send-home?

Step 4 of 15

Medical History

Diagnoses, surgeries, antibiotics, vaccines — the paper trail your body carries.

Current diagnoses

Past diagnoses (resolved)

Surgeries (type + year)

Hospitalizations (reason + year)

Lifetime rounds of antibiotics

Ever had COVID? *

Yes No

How many COVID vaccines have you had?

Child vaccines on schedule? *

Flu shot this year? *

Yes No

Other vaccines (list)

Adverse vaccine reactions

Step 5 of 15

Infections, Injuries & Organs

Things that happened to your body, and what's still there.

Head Injury History

Concussions (lifetime count)

Any knockouts / loss of consciousness?

YesNo

Describe worst head injury / post-concussion symptoms

Step 6 of 15

Mental Health & Skin

Ongoing conditions that shape how you feel day to day.

Skin Issues

Rashes (recurring)

YesNo

Other skin issues (describe)

Step 7 of 15

Medications & Supplements

Everything you take, how much, how long. Be honest about compliance.

Current Medications

Current Supplements

Monthly supplement budget

Step 8 of 15

Lab Work

If you have recent blood work, upload it. We'll read it ourselves.

Date of last blood work

Upload recent lab reports (PDF)

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Drop PDFs here or click to browse

Multiple files OK. Max 10 MB each.

Step 9 of 15

Digestive & Gut Health

Your gut tells the truth even when your labs don't. Get honest.

Step 10 of 15

Hormones & Reproductive Health

Sex-specific sections will appear based on your Step 2 answer.

Shared

Libido (0-10) *

Morning energy (0-10) *

Sleep quality (0-10) *

Hair thinning/loss? *

YesNo

Mood swings *

Female If Sex = Female

Cycle regular?

Cycle length (days)

Menopause status

PMS / period symptoms

Birth control type

Years on birth control

Pregnancies (count)

Male If Sex = Male

On TRT/HRT?

YesNo

Prostate issues

Shared Close

Anything else hormone-related?

Upload hormone test results

↑

Drop PDFs here or click to browse

Saliva, serum, DUTCH — all accepted.

Step 11 of 15

Diet & Nutrition

What you actually eat on a typical day. Be honest — not aspirational.

Current diet type *

Food allergies/intolerances *

Typical Meals

Just write what you normally eat. Examples: "Eggs and toast", "Skip it", "Protein shake and banana", "Whatever's in the fridge".

Typical breakfast

Typical lunch

Typical dinner

First meal of day (time)

Last meal of day (time)

Hydration & More

Water (oz/day) *

Salt type *

Alcohol drinks/week *

Coffee brand/type

Using Bobby Approved app?

YesNo

Step 12 of 15

Lifestyle & Environment

Sleep, stress, exercise, water, EMF, dental. The invisible context that shapes everything.

Sleep & Stress

Sleep hours/night *

Bedtime

Wake time

Daily stress (0-10) *

Screen time (hrs/day)

Sun & Grounding

Daily direct sun (min)

Grounding/barefoot

Water at Home

Drinking water and showering water are often different sources or filtration.

Drinking water source *

Drinking water filter *

Showering water source *

Showering water filter

Water brand (if bottled)

EMF Environment

Step 13 of 15

Genetic & Epigenetic Testing

The Blueprint is mandatory before coaching begins. If you already have testing done, upload it here.

Have you had any genetic testing done?

Check all that apply.

Upload genetic test reports If any test done

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Drop genetic reports here

PDF, TXT, or raw data zip. Max 50 MB.

Step 14 of 15

Therapy Modalities & History

What you've tried in the advanced-therapy world. What worked, what didn't, what you want to try next.

Step 15 of 15

One Last Thing

Before you submit — one acknowledgment, and space to tell us anything else.

Anything else we need to know?

Optional. But the things people are embarrassed to write are usually the things that matter most.

Security check

✓

Ready to Submit

Clicking Submit sends your intake securely to AIFH. We review every submission personally and will follow up within 24–48 hours.

Your Full Picture.Not Just Your Symptoms.

Welcome — Let's Start With Honesty

Contact & Basics

What Brought You Here

Medical History

Infections, Injuries & Organs

Mental Health & Skin

Medications & Supplements

Lab Work

Digestive & Gut Health

Hormones & Reproductive Health

Diet & Nutrition

Lifestyle & Environment

Genetic & Epigenetic Testing

Therapy Modalities & History

One Last Thing

Ready to Submit

Your Full Picture.
Not Just Your Symptoms.