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Specialties
Hormone Replacement Therapy
Bio-Identical Hormone Replacement Therapy in Michigan
BHRT – How it Works
Testosterone Replacement Therapy
Skincare & Aesthetics
SkinPen
Jeaveau for Wrinkles
DermaFrac Microneedling
PlasmaGlow Facials
PlasmaGlow Facelift
Hair Restoration
Sexual Wellness Services
ED Medications
Male Sexual Health Treatments
Women’s Sexual Health Treatments
Men’s Shockwave Therapy
Vaginal Rejuvenation Shot
FemiWave® Shockwave Therapy
Penile Enhancement Shot
Medical Weight Loss
Forum Health’s Medical Weight Loss Program
Detox – The Gut Detox Program – GDRx
IV Therapy
IV Nutritional Therapy in Michigan
Psychedelic-Assisted Therapy
Glutathione IV
Intramuscular Injections
Push & Add On IV Therapy
About
Your Medical Team
About Forum Health
Testimonials
Locations
How it Works
FAQ
Patient Resources
Blog
Labs Direct
Specialties
Hormone Replacement Therapy
Bio-Identical Hormone Replacement Therapy in Michigan
BHRT – How it Works
Testosterone Replacement Therapy
Skincare & Aesthetics
SkinPen
Jeaveau for Wrinkles
DermaFrac Microneedling
PlasmaGlow Facials
PlasmaGlow Facelift
Hair Restoration
Sexual Wellness Services
ED Medications
Male Sexual Health Treatments
Women’s Sexual Health Treatments
Men’s Shockwave Therapy
Vaginal Rejuvenation Shot
FemiWave® Shockwave Therapy
Penile Enhancement Shot
Medical Weight Loss
Forum Health’s Medical Weight Loss Program
Detox – The Gut Detox Program – GDRx
IV Therapy
IV Nutritional Therapy in Michigan
Psychedelic-Assisted Therapy
Glutathione IV
Intramuscular Injections
Push & Add On IV Therapy
About
Your Medical Team
About Forum Health
Testimonials
Locations
How it Works
FAQ
Patient Resources
Blog
Labs Direct
Get Started
Lifestyle Analysis
Lifestyle Analysis
First, tell us about yourself!
Are you male or female?
Are you male or female?
Male
Female
What is your age?
Years of Age
What is your height?
Feet
Inches
What is your current weight?
Weight in lbs.
Are you currently taking any prescription medication?
Are you currently taking any prescription medication?
Yes
No
I want to...
I want to...
Select all that apply
Focus on weight loss or management
Manage my hormone levels
Cope with menopause
Learn how to eat healthier
Cope with aging
Address my aesthetic concerns
Address sexual issues or dysfunction
Improve my overall quality of life
What are your weight loss goals?
What are your weight loss goals?
Quick weight loss (<20 pounds)
Major weight loss (>20 pounds)
Maintain current weight
How motivated are you to lose weight?
How motivated are you to lose weight?
Very motivated
Pretty motivated
Indifferent
Not motivated
What is your goal weight?
Weight in lbs.
How motivated are you to lose weight?
How motivated are you to lose weight?
Very motivated
Pretty motivated
Indifferent
Not motivated
What is your ideal weight?
Weight in lbs.
When was the last time you had lab work done to test your hormone levels?
When was the last time you had lab work done to test your hormone levels?
Less than 6 months
6 months to 1 year
Over 1 Year
Never
What are your primary areas of interest?
What are your primary areas of interest? Select all that apply.
Select all that apply
Wrinkle and/or anti-aging treatments (Face)
Overall skin health & rejuvenation (Face)
Hair growth (Head)
Sexual aesthetics (Intimate)
Other (Whole Person)
What are your primary areas of interest?
What are your primary areas of interest? Select all that apply.
Select all that apply
Erectile Dysfunction
Performance Enhancement
Peyronie’s Disease
Other/I Don't Know
What are your primary areas of interest?
What are your primary areas of interest? Select all that apply.
Select all that apply
Urinary Incontinence
Vaginal Rejuvenation
Other/I Don't Know
How would you rate your lifestyle?
How would you rate your lifestyle?
Select all that apply
Active (Exercise 3 to 5 times a week)
Semi-Active (Exercise 1 to 2 times a week)
A Little Active (Exercise 1 to 2 times a month)
Sedentary (Random exercise)
Very Sedentary (No exercise)
How would you rate your diet?
How would you rate your diet?
Select all that apply
Very healthy
Pretty healthy
Kind of healthy
Not healthy
I’m not sure
To your knowledge, what's been your biggest hurdle to achieving your goals?
To your knowledge, what's been your biggest hurdle to achieving your goals?
Select all that apply.
Age
Hormones or medical issues
Lifestyle
Stress or unhappiness
Lack of support
Lack of access to gyms/personal trainers
Other
Please Specify
What motivates you best?
What motivates you best?
Select all that apply.
Regular feedback
One-on-one guidance
Independent implementation
Rigorous challenges
Step-by-step implementation of ideas and challenges
Other
Please Specify
Please let us know where to send a copy of your Lifestyle Analysis.
Name
*
First
Last
Phone
*
Preferred Callback Time
*
Please select:
Morning
Afternoon
Evening
Email
*
Would you like to subscribe to our newsletter?
Yes!
No thanks.
May we reach out to you via text?
Yes!
No thanks.
Comments
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Answer Questionnaire Above
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