Start Your Assessment | Kinetic Edge Health

Basic Information

How to reach you and confirm eligibility.

First Name *

Last Name *

Date of Birth *

Sex at Birth *

Email *

Phone

State of Residence *

We're a telehealth practice currently licensed in select states. If your state isn't listed, you're welcome to submit and we'll reach out as we expand — but care can only begin once we're licensed where you live. We confirm availability before any clinical evaluation.

Define your top health priorities

Choose up to 3 goals that matter most to you today and rank them from highest to lowest priority (1 to 3).

Weight loss / body recomposition Energy & fatigue Mental clarity & cognition Athletic performance & recovery Sexual performance & libido Hormone optimization Longevity & healthy aging Gut health & inflammation Sleep quality

Which of the following have you previously used or are currently using?

Select all that apply. Include both past and current use.

Nutrition coaching Supplements Hormone therapy GLP-1 or weight-loss medications Peptides None of the above

What motivated you to start now?

Select all that apply.

Recent lab results Low energy or fatigue Weight gain or difficulty losing weight Declining performance (mental or physical) Hormonal concerns Long-term health / longevity Frustration with past approaches Recommendation from someone Other

Anything else you'd like us to know?

What happens next: A member of the Kinetic Edge Health team will review your intake and reach out within 1–2 business days to discuss next steps — typically a lab panel and a live video or phone strategy session with a physician. Any prescription is issued only after that live consultation, never from this form alone. This form is not a medical consultation and does not establish a patient-physician relationship.

You're all set.

Someone from our team will be in touch with you shortly.

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