Comprehensive Male Health Intake Questionnaire

Beyond the Annual Physical. A More Complete Understanding of Men's Health.

Whether your goals involve addressing persistent symptoms, improving physical and cognitive performance, supporting reproductive health, reducing future disease risks, or maintaining vitality as you age, this questionnaire helps us develop a more complete picture of your health and priorities.

We also evaluate your readiness for lifestyle changes, available support systems, previous challenges, and personal goals so that our recommendations can be both clinically appropriate and realistic for your life.

Our objective is not simply to determine whether you have a disease, but to understand the factors affecting your health, identify opportunities for meaningful improvement, and help you build the physical and mental capacity to live and perform at your best.

Most conventional medical intake forms are designed to efficiently document your symptoms, medical diagnoses, medications, and immediate health concerns. Our comprehensive Male Health Intake Questionnaire goes considerably further, helping us understand not only what is happening with your health today, but also the historical, biological, behavioral, and environmental factors that may be influencing your long-term well-being.

Developed by the Institute for Functional Medicine, this detailed assessment examines your personal and family medical history, early development, nutrition, gastrointestinal function, exercise habits, recovery, sleep quality, psychological stress, relationships, environmental exposures, and previous treatment experiences. It also explores important dimensions of men's health, including sexual function, libido, reproductive and testicular health, prostate concerns, urinary symptoms, and age-related changes that may warrant further evaluation.