_Healthier_Choices_{For a Healthier You}

Healthier Choices For a Healthier You

Nice to meet you. Welcome to 5DGenX. Ready?

Firstly, let's gather some general information about you.

What is your name? *

Phone *

Date of birth *

Email *

How do you prefer to be contact?

Phone number

Email

If you haven't added your insurance card yet, you can do so now

Please upload the front of your insurance card

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Please upload the back of your insurance card

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

If you were referred by a current patient please let us know their name so we can contact them to say thanks. (Enter the person's full name) *

What number do we dial to talk to you? (Enter your phone number) *

Street Address *

City *

State *

Postal Code *

What is your marital status?

How tall are you?

What is your current weight?

What is your desired weight goal?

What is your job or profession?

Who should we contact in case of an emergency? *

What is your emergency contact's phone number? *

Now, help us know about your medical history.

List your main health concerns by importance and also state when they started.

List any other wellness issues you have had in the past.

List any medical diagnosis you have received in the past such as diabetes, heart disease, depression, etc.

List any OTC medications or supplements you take and the reasons for taking them.

List any prescription medications you take including dosages and reasons for taking them.

List any past surgeries, hospitalizations, accidents, serious illnesses, and injuries.

List any known allergies to medications.

List any known food or environmental allergies.

Are any of your allergies life threatening? If yes, please specify.

Has anyone in your family (parents, grandparents, siblings, children) been affected by any of the following?

Arthritis

Cancer

AIDS/HIV

Autoimmune disorders

Hormonal imbalance

Pancreatitis

Liver failure

Blood disorders

Dementia

Parkinson's disease

Heart disease

Thyroid problems

None of the above

Add choice

Have you been affected by any of the following?

Arthritis

Cancer

AIDS/HIV

Autoimmune disorders

Limes disease

Hormonal imbalance

Pancreatitis

Liver failure

Kidney stones

Blood disorders

Dementia

Parkinson's disease

Concussion

Head injury

Heart disease

Infertility

Asthma

Seizures

Thyroid problems

Sleep apnea

None of the above

Let's talk about symptoms now

For the following symptoms select how often you experience them - often, sometimes, never, or 'in the past'.

General symptoms.

Head symptoms.

Ear, eyes, nose, and throat symptoms.

Skin symptoms.

Digestion symptoms.

Mental/emotional symptoms.

Cardiovascular symptoms.

Respiratory symptoms.

Neurological symptoms.

Musculoskeletal symptoms.

Urinary symptoms.

Endocrine symptoms.

Now let's talk about some gender specific symptoms. What is your gender?

Male

Female

Male symptoms.

Prostate problems.

Yes

No

Difficult urination.

Often

Sometimes

Never

Erectile dysfunction.

Often

Sometimes

Never

Female symptoms.

Contraceptive use?

Yes

No

What type of contraceptive use?

Absent periods.

Often

Sometimes

Never

Heavy bleeding or spotting between cycles.

Often

Sometimes

Never

Cervical Dysplasia/HPV.

Often

Sometimes

Never

Yeast infections.

Often

Sometimes

Never

Endometriosis

Often

Sometimes

Never

PCOS

Often

Sometimes

Never

Uterine fibroids.

Often

Sometimes

Never

Difficult menopause - hot flashes, night sweat.

Often

Sometimes

Never

Vaginal dryness.

Often

Sometime

Never

Recent changes in breasts.

Yes

No

Nipple discharge.

Yes

No

Date of last PAP exam.

Date

History or abnormal PAP exam.

Yes

No

Let's talk about your lifestyle now.

Do you exercise?

Yes

No

How many times a week do you exercise and what type?

How many alcoholic drinks do you consume every week?

Non

1 - 2

2 - 4

4+

Do you use recreational drugs?

Yes

No

Rate your current stress level.

1 - Lowest

2 - Low

3 - Medium

4 - High

5 - Highest

What are the primary sources of your stress? (Yes, the thoughts in your head that just popped up.)

How times a week do you eat fast food?

None

1 - 2

3 - 5

6+

What is the amount of soda (including diet) you drink on average per day? (Enter amount in milliliters (ml)

How many times do you eat per day?

How many glasses of water do you drink every day?

1 - 3

3 - 5

6 - 8

8+

How many cups of coffee do you drink per day?

None

1 - 2

2 - 4

4+

Are you drinking water from a source you know has minerals or using mineral drops?

Never

Sometimes

Always

I don't know

Tell us about your health goals.

Your health is not a guessing game. Know before you go.

NEXT

Nice to meet you. Welcome to 5DGenX. Ready?

Firstly, let's gather some general information about you.

What is your name? *

Phone *

Date of birth *

Email *

How do you prefer to be contact?

Phone number

Email

If you haven't added your insurance card yet, you can do so now

Please upload the front of your insurance card

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Please upload the back of your insurance card

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

If you were referred by a current patient please let us know their name so we can contact them to say thanks. (Enter the person's full name) *

What number do we dial to talk to you? (Enter your phone number) *

Street Address *

City *

State *

Postal Code *

What is your marital status?

How tall are you?

What is your current weight?

What is your desired weight goal?

What is your job or profession?

Who should we contact in case of an emergency? *

What is your emergency contact's phone number? *

Now, help us know about your medical history.

List your main health concerns by importance and also state when they started.

List any other wellness issues you have had in the past.

List any medical diagnosis you have received in the past such as diabetes, heart disease, depression, etc.

List any OTC medications or supplements you take and the reasons for taking them.

List any prescription medications you take including dosages and reasons for taking them.

List any past surgeries, hospitalizations, accidents, serious illnesses, and injuries.

List any known allergies to medications.

List any known food or environmental allergies.

Are any of your allergies life threatening? If yes, please specify.

Has anyone in your family (parents, grandparents, siblings, children) been affected by any of the following?

Arthritis

Cancer

AIDS/HIV

Autoimmune disorders

Hormonal imbalance

Pancreatitis

Liver failure

Blood disorders

Dementia

Parkinson's disease

Heart disease

Thyroid problems

None of the above

Add choice

Have you been affected by any of the following?

Arthritis

Cancer

AIDS/HIV

Autoimmune disorders

Limes disease

Hormonal imbalance

Pancreatitis

Liver failure

Kidney stones

Blood disorders

Dementia

Parkinson's disease

Concussion

Head injury

Heart disease

Infertility

Asthma

Seizures

Thyroid problems

Sleep apnea

None of the above

Let's talk about symptoms now

For the following symptoms select how often you experience them - often, sometimes, never, or 'in the past'.

General symptoms.

Head symptoms.

Ear, eyes, nose, and throat symptoms.

Skin symptoms.

Digestion symptoms.

Mental/emotional symptoms.

Cardiovascular symptoms.

Respiratory symptoms.

Neurological symptoms.

Musculoskeletal symptoms.

Urinary symptoms.

Endocrine symptoms.

Now let's talk about some gender specific symptoms. What is your gender?

Male

Female

Male symptoms.

Prostate problems.

Yes

No

Difficult urination.

Often

Sometimes

Never

Erectile dysfunction.

Often

Sometimes

Never

Female symptoms.

Contraceptive use?

Yes

No

What type of contraceptive use?

Absent periods.

Often

Sometimes

Never

Heavy bleeding or spotting between cycles.

Often

Sometimes

Never

Cervical Dysplasia/HPV.

Often

Sometimes

Never

Yeast infections.

Often

Sometimes

Never

Endometriosis

Often

Sometimes

Never

PCOS

Often

Sometimes

Never

Uterine fibroids.

Often

Sometimes

Never

Difficult menopause - hot flashes, night sweat.

Often

Sometimes

Never

Vaginal dryness.

Often

Sometime

Never

Recent changes in breasts.

Yes

No

Nipple discharge.

Yes

No

Date of last PAP exam.

Date

History or abnormal PAP exam.

Yes

No

Let's talk about your lifestyle now.

Do you exercise?

Yes

No

How many times a week do you exercise and what type?

How many alcoholic drinks do you consume every week?

Non

1 - 2

2 - 4

4+

Do you use recreational drugs?

Yes

No

Rate your current stress level.

1 - Lowest

2 - Low

3 - Medium

4 - High

5 - Highest

What are the primary sources of your stress? (Yes, the thoughts in your head that just popped up.)

How times a week do you eat fast food?

None

1 - 2

3 - 5

6+

What is the amount of soda (including diet) you drink on average per day? (Enter amount in milliliters (ml)

How many times do you eat per day?

How many glasses of water do you drink every day?

1 - 3

3 - 5

6 - 8

8+

How many cups of coffee do you drink per day?

None

1 - 2

2 - 4

4+

Are you drinking water from a source you know has minerals or using mineral drops?

Never

Sometimes

Always

I don't know

Tell us about your health goals.

Your health is not a guessing game. Know before you go.

NEXT

Health Problems We Support

Weight Loss

Autoimmune Conditions

Digestive Issues

Hormonal & Fertility Issues

Skin Conditions

Complex Conditions

Mental Health

Prevention/Optimisation

Sports Nutrition

Health Problems We Support

Weight Loss

Autoimmune Conditions

Digestive Issues

Hormonal Issues

Skin Conditions

Complex Conditions

Mental Health

Prevention/Optimisation

Sports Nutrition

Book An Appointment Now

Book An Appointment Now

Unlock insights into your health with our comprehensive lab testing service, assessing over 150 biomarkers and health indicators. From hormone levels to gut health and beyond, our thorough analysis provides personalized reports and recommendations to empower your wellness journey. Schedule your test today to take control of your health.

Our Simple Process

Book a consultation

Start your programme

Implement in your life

Experience new health results

Our Simple Process

Book a consultation

Imagine your body brimming with energy, your immunity a fortress, and your health a long-term investment.

Start your programme

Ever wonder what’s going on beneath the surface?

Implement in your life

We will help you make lifestyle change.

Experience new health results

Enjoy an improved life quality and feel confident and knowledgable in your own health.

About Company

Unlock insights into your health with our comprehensive lab testing service, assessing over 150 biomarkers and health indicators. From hormone levels to gut health and beyond, our thorough analysis provides personalized reports and recommendations to empower your wellness journey.

Complete Health Analysis

Understanding your complete health history,family health history, and providing laboratory testing to find the root cause of your problems

Actionable Health Roadmap

Understanding your complete health history, family health history, and providing laboratory testing to find the root cause of your problems

Tracking Your Results

Understanding your complete health history, family health history, and providing laboratory testing to find the root cause of your problems

Recipes, Shopping, Chefs

Understanding your complete health history, family health history, and providing laboratory testing to find the root cause of your problems

Call us: (786) 204-1378

Tracking Your Results

Tired of chasing symptoms? Crack the health code with integrative testing! By analyzing various clues (test results), we can uncover the root cause of your health concerns.

Life Support

We empower you to take control and craft a personalized path to optimal well-being. Ready to become the detective of your own health?

What client say about us

"After undergoing stem cell therapy at 5DGENX®, I have regained full mobility in my knee, and I am pain-free!"

Stacey P.

"I never thought I could heal from my injury, but
5DGENX® tissue engineering technology proved me wrong. I'm living proof that regenerative medicine works!"

Kate H.

What client say about us

"I never thought I could heal from my injury, but 5DGENX® tissue engineering technology proved me wrong. I'm living proof that regenerative medicine works!"

Kate H.

“I was constantly on the diet cycle – I’d start dieting, lose weight, stop dieting, gain weight and start all over again 5DGENX® broke the cycle. 5DGENX® has become a permanent part of my daily life"

Stacey P

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Contact Us

(786) 204-1378

[email protected]

Miami, Florida

©2024 5dgenx

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Contact Us

+1 786-204-1378

[email protected]

Miami, Florida