Client Intake

Your Full Picture.
Not Just Your Symptoms.

This isn't a form to fill out. It's a full picture of you — so we can find the root cause, not just the symptom.

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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.

I don't work with symptoms. I work with people who want answers. If that's you — be brutally honest on every question. The stuff you're tempted to skip is usually the stuff that matters most. — David

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Contact & Basics

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

Emergency Contact
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What Brought You Here

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

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Medical History

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

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Infections, Injuries & Organs

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

Chronic Infection History
Head Injury History
Organ Status
Do you still have your…
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Mental Health & Skin

Ongoing conditions that shape how you feel day to day.

Mental Health History
Skin Issues
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Medications & Supplements

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

Current Medications
Current Supplements
Medication Category Flags
These drive safety rules in your protocol. Yes/No each.
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Lab Work

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

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Drop files here or click to browse
PDF, Word, JSON, TXT, CSV — up to 5 MB each
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Digestive & Gut Health

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

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Hormones & Reproductive Health

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

Shared
Female If Sex = Female
Male If Sex = Male
Shared Close
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Drop files here or click to browse
Saliva, serum, DUTCH — PDF, Word, JSON — up to 5 MB each
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Diet & Nutrition

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

Typical Meals
Just write what you normally eat. Examples: "Eggs and toast", "Skip it", "Protein shake and banana", "Whatever's in the fridge".
Hydration & More
Tobacco
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Lifestyle & Environment

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

Sleep & Stress
Exercise
Sun & Grounding
Water at Home
Drinking water and showering water are often different sources or filtration.
EMF Environment
Dental Health
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Genetic & Epigenetic Testing

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

Check all that apply.
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Drop files here or click to browse
PDF, TXT, raw data ZIP — up to 5 MB each
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Therapy Modalities & History

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

What You've Tried
Modalities of Interest
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One Last Thing

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

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

Review & Submit

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

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