New Patients

Aeternitas Patient Intake

Eight short forms that give your physician a complete picture of your health before your evaluation. Work through them in order, at your own pace. Most people complete the intake across several sittings over a week — there is no need to finish in one sitting.

Work in order

Start at the top and move down. The forms are arranged to flow naturally from one to the next.

Submit to Save

Each form saves when you submit it. Ensure you complete the entire form to submission.

Track Progress

Check marks on this page notate when each section is complete.

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2–3 Hours

That’s the whole intake, spread across as many sittings as you like. Each form below shows its own estimate.

0 of 8 forms complete

1. Welcome & GoalsCompleted15 min

A gentle start — what brought you to Aeternitas, what you're hoping to address, and the health priorities that matter most to you.

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2. Core Medical HistoryCompleted15 min

Your medical background: past and current conditions, surgeries, medications, and allergies. The foundation your physician builds from.

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3. Family HistoryCompleted25 min

Health patterns in your immediate family. This helps your physician understand hereditary risk and where to focus preventive care.

Before you start, you may want a few family health details on hand.

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4. Body Systems ReviewCompleted20 min

A structured review across the body's major systems — heart, metabolism, hormones, and more. Most questions appear only if they're relevant to you, so it moves faster than it looks.

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5. SleepCompleted15 min

How you sleep — patterns, quality, and rest. Sleep is one of the clearest signals of long-term health, so we look at it closely.

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6. NutritionCompleted15 min

How you eat day to day. Not a food diary — a picture of the patterns that shape your metabolic health.

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7. Movement & ExerciseCompleted15 min

How you move — activity, exercise, and physical function. This shapes how your physician thinks about strength and resilience over time.

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8. Emotional HealthCompleted25 min

Mood, stress, and emotional wellbeing. These questions are personal by design — they give your physician a fuller understanding of your health, and your answers are held in confidence.

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Checkmarks appear here when we receive your form — usually right away. Not seeing one after you’ve submitted? Call us and we’ll sort it out.

Almost there

When all eight are complete

Reply to our welcome email or give us a call — we’ll take it from there. Your physician reviews everything before your evaluation day.

Questions as you go? Call us at (704) 200-9911.