Evaspan — Consultation Intake

Consultation email

Personal & Lifestyle Context

Daily rhythm, routines and natural tendencies.

Full Name Email Sex Pregnancy / Postpartum Date of Birth Occupation Type Daily Routine Predictability Natural Energy Pattern Preferred Training Time

Health & Medical Background

Medical considerations and risk screening.

Logistics & consents

Practicalities for planning and data handling.

Weekly time available for training (hours)

Be realistic—drives programme volume.

Monthly budget for health (£)

Helps us tailor recommendations.

Lead source Consent for medical data processing

Required to store biomarkers and clinical notes.

Consent for wearable data access

Oura, Garmin, Apple Health, etc.

Medical clearance required?

Use “Yes” for flags like chest pain, dizziness, or recent cardiac events.

Goals & Motivation

What success looks like over the next 12 months.

Sleep & Circadian

Consistency and depth of recovery.

Average Sleep Duration Sleep Quality (1-10) Wake Time Consistency Morning Hunger Phone Use Within 10 Minutes of Waking Screen Use Within 1 Hour of Bed Caffeine Intake

Include coffee, energy drinks, strong tea.

Caffeine Timing

Later caffeine can disrupt sleep.

Caffeine Sensitivity

Helps us set a sensible cut-off time.

Nutrition & Hydration

Eating patterns and metabolic signals.

Eating Pattern Estimated Daily Protein Intake Daily Fluid Intake Ultra Processed Food Frequency Evening Snacking Frequency Emotional Eating Under Stress

Longevity Supplementation Profile

Current Supplement Use

Omega-3 Vitamin D3 Creatine Monohydrate NR / NMN / NAD+ boosters Magnesium Multivitamin Electrolytes None

Supplement Consistency Supplement Source Quality Interest in Longevity-Focused Supplement Strategy Oily Fish Intake Sunlight Exposure Creatine Familiarity NR / NAD Familiarity

Activity, Fitness & Movement

Structured training and daily movement.

Weekly Structured Activity Level Strength Training Frequency Cardio Training Frequency Zone 2 Cardio Training Frequency Daily Step Count (estimate) Stairs vs Lift Outdoor Walking Time Per Day

Stress, Workload & Recovery Capacity

Training load must match capacity to recover.

Perceived Daily Stress Mood Stability Mental Fatigue Workload Intensity Work Predictability Time Sitting Per Day

Social & Preferences

Environment, accountability and logistics.

Behaviour & Coaching

Task Follow-Through Score Reaction to Setbacks Disliked foods / exclusions Notes