Optimizing Health

Patient Intake

Welcome to Big Sandy Medical Center's Optimizing Health Program. This intake helps us understand your health story before your visit so we can make the most of your time together.

~30 min

Estimated time to complete

16 sections

Health history, lifestyle, and goals

Save as you go

Use the Previous button if you need to revise an answer

One more form to complete

The Metabolic Assessment is a short symptom checklist used alongside the comprehensive intake. Please complete it as well — it takes about 5–10 minutes.

Open Metabolic Assessment

Personal Information
Contact Information
Health Goals and Struggles
Health Background
Medications and Supplements
Family History
Women's Health
Men's Health
Nutrition and Diet
Stress and Nervous System
Sleep
Movement and Muscle Health
Digestion and Gut Health
Labs and Previous Testing
Health Timeline
Readiness and Expectations

First Name

Last Name

Date of Birth

Gender

Are you OK with being contacted by text message?

I am voluntarily providing this health information to Big Sandy Medical Center so that BSMC can evaluate and respond to my request for services. I acknowledge that I have been offered BSMC's Notice of Privacy Practices, which describes how my health information may be used and disclosed for treatment, payment, and health care operations, and my rights regarding that information. I understand that this form is transmitted over the internet, is not monitored continuously, and must not be used for urgent or emergency medical needs - in an emergency I will call 911 or go to the nearest emergency room.

Generate a new image Play the audio code

Enter the code from the image