Blood Work Questionnaire

Important Timing Information

If you are on TRT: Your blood test should be conducted on the morning of the day you are due to inject, BEFORE you inject.

This provides the most accurate representation of your trough (lowest) levels.

⚠️ CRITICAL: Your booking for your hormone panel MUST be on the morning you are due to re-inject, BEFORE you inject!

Please provide details of your current TRT protocol *

Include: compound/ester, dosage, frequency, route of administration

How long have you been on TRT?

Less than 3 months 3-6 months 6-12 months 1-2 years Over 2 years

Is this TRT prescribed by a medical professional?

Yes - NHS prescribed Yes - Private clinic prescribed Self-administered / UGL

4 Hormone Replacement Therapy (HRT)

Are you currently on Hormone Replacement Therapy (HRT)? *

For female patients: oestrogen, progesterone, or combined therapy

Yes - I am on HRT No - I am not on HRT

Please provide details of your current HRT protocol *

Include: hormones used, dosage, frequency, route of administration

Type of HRT

Oestrogen only Progesterone only Combined (oestrogen + progesterone) Testosterone (for females) Other

How long have you been on HRT?

Less than 3 months 3-6 months 6-12 months 1-2 years Over 2 years

Is this HRT prescribed by a medical professional?

Yes - NHS prescribed Yes - Private clinic prescribed Self-administered

Have you taken your most recent dose?

Yes - taken this morning No - due to take today (trough reading) Not applicable (non-injection protocol)

5 Performance Enhancing Drugs (PEDs)

⚠️ Medical Advisory

We strongly recommend consulting a medical professional if you are using performance enhancing drugs. We can provide harm reduction guidance but this does not replace proper medical supervision.

Important Timing Information

For PED users: Your blood test should be conducted on the morning of the day you are due to administer, BEFORE administration.

This timing is critical for accurate trough level assessment.

Please provide details of your current or recent PED protocol *

Include: all compounds used, dosages, frequency, cycle duration, and any ancillaries

Please specify any other compounds

Current cycle duration

Just started (0-4 weeks) Mid-cycle (4-12 weeks) End of cycle (12-16 weeks) Cruising/TRT between cycles Post-cycle/off cycle (currently) Blast and cruise protocol

When was your last administration?

This morning (before blood draw) Yesterday 2-3 days ago 4-7 days ago Over 1 week ago Due today (haven't taken yet)

Are you running any support supplements or ancillaries?

Purpose of this test

Pre-cycle baseline Mid-cycle check Post-cycle/PCT monitoring Health monitoring while cruising Investigating side effects

Have you disclosed your PED use to your GP or healthcare provider?

Yes No Prefer not to say

6 Current Health Status

7 Symptoms Checklist

8 Relevant Health History

9 Current Medications & Supplements

⚠️ Critical Question: Biotin Supplementation

Biotin (Vitamin B7) interferes with many thyroid and hormone assays and can cause false results. Please answer honestly.

Are you taking any supplements containing biotin? *

This includes: B-complex vitamins, hair/skin/nail supplements, multivitamins, "metabolism support" supplements

Yes No Not sure - I will check my supplements

10 Lifestyle Factors

Alcohol consumption *

This can affect liver enzymes and other biomarkers

None Occasional (1-2 drinks/week) Moderate (3-7 drinks/week) Regular (8-14 drinks/week) Heavy (15+ drinks/week)

Blood Work Questionnaire

1 Client Details

2 Test Context

3 Testosterone Replacement Therapy (TRT)

Important Timing Information

4 Hormone Replacement Therapy (HRT)

5 Performance Enhancing Drugs (PEDs)

⚠️ Medical Advisory

Important Timing Information

6 Current Health Status

7 Symptoms Checklist

8 Relevant Health History

9 Current Medications & Supplements

⚠️ Critical Question: Biotin Supplementation

10 Lifestyle Factors

11 Your Goals

Consent & Confirmation