VitalReach wellness center

Prepare for your consultation

Choose the checklists your practitioner requested. Answer what you know and leave anything uncertain as “Unknown.” This adult intake supports a conversation with a clinician; it does not diagnose disease.

First, your safety

These questions concern symptoms happening now.

Chest pain or pressure happening now Severe difficulty breathing, confusion, collapse, or difficulty staying awake now Sudden face droop, one-sided arm weakness, speech difficulty, vision loss, loss of balance, or a sudden worst-ever headache now Thoughts of self-harm or suicide now, or unable to keep yourself safe Persistent vomiting with rapid/deep breathing or severe dehydration now

Your details

Full name * Age (18+) * Sex Pregnant or recently postpartum? Phone or email (optional)

Visitors under 18: ask staff for an assisted assessment. Pregnancy and postpartum readings need individual clinical interpretation.

Choose your checklists *

Select those requested by your practitioner. You can choose more than one.

Kidney health Blood pressure and pain medicines Cardiovascular and stroke health Diabetes screening Liver health and medicines Medicine dependence and mental wellbeing

Notes and consent

Anything else your clinician should know? Include symptom onset times if relevant.

Your answers and screening flags will be stored for your consultation and accessed by authorized clinical reviewers. They are not used for marketing. Automated flags may be incomplete or incorrect and require clinical review. Ask center staff about access, correction, or deletion of your information.

Read our Privacy Policy and consultation terms (version 2026-09-30.2). These links open a new tab so you can keep your form open.

I agree to the collection and clinical review of my health information for this consultation, including automated screening flags. *