Step 1 of 6

Start your doctor consultation questionnaire.

A few short questions help a qualified Australian doctor understand your situation before your consultation. This is an intake questionnaire, not a consultation, and it is not used on its own to make clinical decisions. Answer at your own pace, and more than one question appears on each page.

Prefer to talk it through first? Book a free 10-minute discovery call with a founder, Ken or Adam. They talk through your goals, answer your questions about how the clinic works, and help you find the right next step. It is not a medical consultation. Your care itself is always led by a qualified Australian doctor.

Book a free discovery call

What are you looking to improve?

Select all that apply.

What is your #1 priority right now?

Choose the one that matters most to you today.

Step 2 of 6

How have you been feeling lately?

There are no right or wrong answers. Share what feels true for you.

Are you currently experiencing any of the following?

Select all that apply.

How long have you been experiencing these?

How much do these impact your daily life?

Step 3 of 6

A little about you.

We use these details to confirm you are the person receiving care, to create your clinical record, and to arrange any pathology with an accredited lab where that is relevant.

Your details

Full name

Email address

Please note: this email address will be used to log in to your Patient Portal and for future correspondence.

Contact number

Gender

Date of birth

Address

Medicare card number Optional

Our consultations are private-pay, so we do not need this to see you. Give it only if you would like us to record it for a referral or a service where Medicare claiming applies.

Driver's licence number Optional

Used only to verify your identity. If you would rather not give a licence number, leave this blank and our care team will verify your identity another way before your consultation.

Why we ask for this

Who is collecting it. Advanced Performance Clinic Pty Ltd (ABN 62 696 381 825). You can reach us at [email protected].
Why we need it. To confirm you are the person receiving care, to create and keep your clinical record accurately, and to arrange pathology or a prescription where your doctor recommends one.
What is optional. The Medicare and driver's licence fields are optional. Leaving them blank does not stop you booking a consultation.
How it is stored. In our clinical record system in Australia, protected by access controls and retained for the period set out in our Privacy Policy.
Who we may share it with. Your treating doctor, a pathology provider where testing is arranged, and a dispensing pharmacy where a prescription is issued. We do not sell your information.

I confirm I am 18 years or older. Our telehealth consultations are for adults aged 18 and over.

We see members Australia-wide via telehealth.

Step 4 of 6

Your health and medical history.

This helps your doctor review your circumstances safely and properly. Share what you can, and mention anything else in your own words at the end.

Do you have any diagnosed medical conditions?

Medical history

Select all that apply.

Are you currently taking any medications?

Do you have any current injuries?

Have you had any past surgeries?

Cardiovascular risk

Select any that apply to you or your immediate family.

Do you experience any of the following?

Select all that apply.

Step 5 of 6

Your lifestyle.

A snapshot of your training, diet and habits gives your doctor helpful context.

Training frequency

Sessions per week.

Training type

Select all that apply.

Diet quality

Alcohol consumption

Smoking

Have you previously used any hormone-related or peptide therapies?

Select all that apply.

Is there anything else you'd like your clinician to know before your consultation?

How did you hear about Advanced Performance Clinic?

This helps us understand where our members find us.

By submitting, you agree to our Privacy Policy and Terms of Service. We use your details to assess your suitability for a consultation and to arrange it with you.

Start your doctor consultation questionnaire.

How have you been feeling lately?

A little about you.

Your health and medical history.

Your lifestyle.

Choose a time that suits you.

Next: your blood test.