HealthScreen
Clinical Intake System
1
Biometrics
2
PAR-Q+
3
Lifestyle
4
MSK Pain
5
Goals
Step 1: Biometrics
Full Name
Age
Biological Sex
Select
Male
Female
Intersex
Ethnicity
Select
South Asian
East Asian
Southeast Asian
Black
Hispanic/Latino
Middle Eastern
White
Mixed / Other
Weight
(lbs)
Height
(inches)
Body Fat
(%)
Waist Circumference
(inches, optional)
Step 2: PAR-Q+ Cardiovascular Screening
Step 3: Lifestyle
Work Type
Select
Sedentary
Light Activity
Moderate Activity
Heavy Labor
Exercise Days/Week
Exercise Type
Daily Water Intake
Select
Under 1 L
1 - 2 L
2 - 3 L
3+ L
Fast Food Frequency
Select
Rarely
1 - 2 times/week
3 - 4 times/week
5+ times/week
Average Sleep
Select
< 5 hours
5 - 6 hours
7 - 8 hours
9+ hours
Smoking Status
Select
Never
Former
Occasional
Daily
Stress Level (1-10)
5
Step 4: MSK Pain Screening
Pain Areas
Pain Intensity (0-10)
0
Pain Duration
None
Acute (< 6 weeks)
Subacute (6-12 weeks)
Chronic (> 12 weeks)
Functional Impact
Injury History
Step 5: Goals & Notes
Health Goals
Energy Level
Select
Low
Moderate
High
Digestion Issues
Additional Clinical Notes
Back
Next
Generate Clinical Report
Generating Clinical Risk Assessment...
Validating intake data
Calculating biometrics
Screening risk domains
Compiling SOAP note
Finalizing report
Login
Sign Up
Remember me
Forgot Password?
Sign in
I accept the
Terms of Service and Privacy Policy
Sign Up
Lost your password? Please enter your username or email address. You will receive a link to create a new password via email.
Email Reset Link
body::-webkit-scrollbar { width: 7px; } body::-webkit-scrollbar-track { border-radius: 10px; background: #f0f0f0; } body::-webkit-scrollbar-thumb { border-radius: 50px; background: #dfdbdb }
WhatsApp us