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Weight Loss Assessment

A few quick questions so our doctors can tailor your plan.

Step 1 of

Thanks! Your assessment is in. Our doctors will review it and, once approved, your treatment will appear on your Treatments page.

If you don’t see your treatment on the Treatments page, try refreshing after a few moments.

Complete this step to continue.

[{"title":"Your Details","subtitle":"Let's start with a few basics.","fields":[{"name":"email","label":"Email Address","type":"email","required":true,"prefill":""},{"name":"phone","label":"Mobile Number","type":"text","placeholder":"","required":true},{"name":"dateofbirth","label":"Date of Birth","type":"date","required":true},{"name":"height","label":"Height (cm)","type":"text","placeholder":"e.g. 165","required":true},{"name":"weight","label":"Weight (kg)","type":"text","placeholder":"e.g. 70","required":true},{"name":"pz_bmi","label":"BMI (auto-calculated)","type":"text","placeholder":"Calculated from your height & weight"}]},{"title":"Medical History","subtitle":"Tell us about your general health.","fields":[{"name":"mf_has_medical_conditions","label":"Do you have any current or past medical conditions?","type":"radio","options":["Yes","No"],"required":true},{"name":"medical_conditions","label":"Please describe your medical conditions","type":"textarea","placeholder":"e.g. thyroid, diabetes, heart disease, autoimmune","showIf":{"field":"mf_has_medical_conditions","value":"Yes"}},{"name":"mf_taking_prescription_meds","label":"Are you currently taking any prescription medications?","type":"radio","options":["Yes","No"],"required":true},{"name":"pz_medications","label":"Please list your prescription medications (incl. dose if known)","type":"textarea","placeholder":"List each medication","showIf":{"field":"mf_taking_prescription_meds","value":"Yes"}},{"name":"mf_taking_otc_supplements","label":"Are you taking any over-the-counter medications or supplements?","type":"radio","options":["Yes","No"],"required":true},{"name":"mf_has_allergies_sensitivities","label":"Do you have any allergies or sensitivities?","type":"radio","options":["Yes","No"],"required":true},{"name":"pz_allergies","label":"Please describe your allergies or sensitivities","type":"textarea","placeholder":"Food, medications, chemicals, etc.","showIf":{"field":"mf_has_allergies_sensitivities","value":"Yes"}},{"name":"mf_had_surgeries_major_events","label":"Have you had any surgeries or major medical events?","type":"radio","options":["Yes","No"],"required":true},{"name":"pz_surgical_procedures","label":"Please provide details of surgeries / major events","type":"textarea","placeholder":"Procedure and approximate date","showIf":{"field":"mf_had_surgeries_major_events","value":"Yes"}}]},{"title":"Treatment History","subtitle":"What you've tried before.","fields":[{"name":"mf_tried_rehab_diets_meds_before","label":"Have you previously tried programs, diets, or medications for these goals?","type":"radio","options":["Yes","No"],"required":true},{"name":"mf_used_prescription_pain_relief_before","label":"Have you used prescription pain relief before?","type":"radio","options":["Yes","No"],"required":true},{"name":"mf_discussed_with_gp_allied_health","label":"Have you discussed these goals with your GP or an allied health professional?","type":"radio","options":["Yes","No"],"required":true},{"name":"mf_used_peptides_before","label":"Have you used peptides before?","type":"radio","options":["Yes","No"],"required":true},{"name":"mf_peptide_side_effects","label":"Did you experience any side effects from peptides?","type":"radio","options":["Yes","No"],"showIf":{"field":"mf_used_peptides_before","value":"Yes"}},{"name":"mf_used_hormone_therapy","label":"Have you used hormone therapy before?","type":"radio","options":["Yes","No"],"required":true}]},{"title":"Your Goals & Symptoms","subtitle":"What you'd like to achieve and how you feel right now.","fields":[{"name":"mf_primary_goals","label":"What are your primary goals? 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(select all that apply)","type":"checkbox","options":["Enhanced energy","Visible body composition changes","Better sleep","Faster recovery from training","Improved mental clarity","Reduced pain / inflammation"]}]},{"title":"Lifestyle","subtitle":"A few quick lifestyle questions.","fields":[{"name":"med_smoking","label":"Do you smoke or vape?","type":"radio","options":[{"label":"No","value":"no"},{"label":"Yes","value":"yes"},{"label":"Former smoker/vaper","value":"former"}],"required":true},{"name":"med_alcohol","label":"Do you consume alcohol?","type":"radio","options":[{"label":"No","value":"no"},{"label":"Yes","value":"yes"}],"required":true},{"name":"med_alcohol_frequency","label":"How many standard drinks per week?","type":"radio","options":[{"label":"1–3","value":"1_3"},{"label":"4–7","value":"4_7"},{"label":"8–14","value":"8_14"},{"label":"15+","value":"15_plus"}],"showIf":{"field":"med_alcohol","value":"yes"}},{"name":"mf_recreational_drugs","label":"Do you use any recreational drugs?","type":"radio","options":["Yes","No"],"required":true}]},{"title":"Activity & Exercise","subtitle":"How you move day to day.","fields":[{"name":"med_exercise_frequency","label":"How often do you exercise?","type":"radio","options":[{"label":"None","value":"none"},{"label":"1–2 sessions/week","value":"1_2"},{"label":"3–4 sessions/week","value":"3_4"},{"label":"5+ sessions/week","value":"5_plus"}],"required":true},{"name":"mf_exercise_types","label":"What types of exercise do you do? (select all that apply)","type":"checkbox","options":["Strength / Resistance","Cardio","Flexibility / Mobility","Mixed / Functional"]},{"name":"med_work_activity","label":"How active are you at work?","type":"radio","options":[{"label":"Sedentary","value":"sedentary"},{"label":"Lightly active","value":"lightly_active"},{"label":"Moderately active","value":"moderately_active"},{"label":"Highly physical","value":"highly_physical"}],"required":true}]},{"title":"Sleep & Recovery","subtitle":"How you're sleeping.","fields":[{"name":"med_sleep_hours","label":"How many hours do you sleep per night?","type":"radio","options":[{"label":"<5","value":"under_5"},{"label":"5–6","value":"5_6"},{"label":"6–7","value":"6_7"},{"label":"7–8","value":"7_8"},{"label":"8+","value":"8_plus"}],"required":true},{"name":"med_sleep_difficulties","label":"Do you have any difficulties with sleep? (select all that apply)","type":"checkbox","options":[{"label":"Falling asleep","value":"falling_asleep"},{"label":"Staying asleep","value":"staying_asleep"},{"label":"Early waking","value":"early_waking"},{"label":"Sleep feels unrefreshing","value":"unrefreshed"},{"label":"None","value":"none"}]},{"name":"mf_uses_sleep_aids","label":"Do you use any sleep aids?","type":"radio","options":["Yes","No"],"required":true}]},{"title":"Medicare / IHI Details","subtitle":"Your details are securely stored and only accessible to our clinical team. This information is required under Australian telehealth regulations for prescribing medication.","fields":[{"name":"medicare_or_ihi","label":"Which healthcare identifier do you have?","type":"radio","options":[{"label":"Medicare","value":"medicare"},{"label":"IHI","value":"ihi"}],"required":true},{"name":"medicarenumber","label":"Medicare Card Number","type":"text","required":true,"showIf":{"field":"medicare_or_ihi","value":"medicare"}},{"name":"medicarereference","label":"IRN (Reference Number)","type":"text","required":true,"showIf":{"field":"medicare_or_ihi","value":"medicare"}},{"name":"medicareexpiry","label":"Expiry Date","type":"date","required":true,"showIf":{"field":"medicare_or_ihi","value":"medicare"}},{"name":"ihi_number","label":"IHI Number","type":"text","required":true,"showIf":{"field":"medicare_or_ihi","value":"ihi"}}]},{"title":"Identity & Consent","subtitle":"Last step — verify your identity and confirm consent.","fields":[{"name":"licence_photo_url","label":"Upload a photo of your photo ID (driver's licence or passport)","type":"file","required":true},{"name":"signed_name","label":"Type your full name as your signature","type":"text","required":true},{"name":"agreed_to_terms","label":"Consent","type":"checkbox","options":[{"label":"I confirm the information provided is accurate, and I consent to a telehealth consultation with a Modern Female doctor.","value":"true"}]}]}]

Energy Assessment

A few quick questions so our doctors can tailor your plan.

Step 1 of

Thanks! Your assessment is in. Our doctors will review it and, once approved, your treatment will appear on your Treatments page.

If you don’t see your treatment on the Treatments page, try refreshing after a few moments.

Complete this step to continue.

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(select all that apply)","type":"checkbox","options":["Enhanced energy","Visible body composition changes","Better sleep","Faster recovery from training","Improved mental clarity","Reduced pain / inflammation"]}]},{"title":"Lifestyle","subtitle":"A few quick lifestyle questions.","fields":[{"name":"med_smoking","label":"Do you smoke or vape?","type":"radio","options":[{"label":"No","value":"no"},{"label":"Yes","value":"yes"},{"label":"Former smoker/vaper","value":"former"}],"required":true},{"name":"med_alcohol","label":"Do you consume alcohol?","type":"radio","options":[{"label":"No","value":"no"},{"label":"Yes","value":"yes"}],"required":true},{"name":"med_alcohol_frequency","label":"How many standard drinks per week?","type":"radio","options":[{"label":"1–3","value":"1_3"},{"label":"4–7","value":"4_7"},{"label":"8–14","value":"8_14"},{"label":"15+","value":"15_plus"}],"showIf":{"field":"med_alcohol","value":"yes"}},{"name":"mf_recreational_drugs","label":"Do you use any recreational drugs?","type":"radio","options":["Yes","No"],"required":true}]},{"title":"Activity & Exercise","subtitle":"How you move day to day.","fields":[{"name":"med_exercise_frequency","label":"How often do you exercise?","type":"radio","options":[{"label":"None","value":"none"},{"label":"1–2 sessions/week","value":"1_2"},{"label":"3–4 sessions/week","value":"3_4"},{"label":"5+ sessions/week","value":"5_plus"}],"required":true},{"name":"mf_exercise_types","label":"What types of exercise do you do? (select all that apply)","type":"checkbox","options":["Strength / Resistance","Cardio","Flexibility / Mobility","Mixed / Functional"]},{"name":"med_work_activity","label":"How active are you at work?","type":"radio","options":[{"label":"Sedentary","value":"sedentary"},{"label":"Lightly active","value":"lightly_active"},{"label":"Moderately active","value":"moderately_active"},{"label":"Highly physical","value":"highly_physical"}],"required":true}]},{"title":"Sleep & Recovery","subtitle":"How you're sleeping.","fields":[{"name":"med_sleep_hours","label":"How many hours do you sleep per night?","type":"radio","options":[{"label":"<5","value":"under_5"},{"label":"5–6","value":"5_6"},{"label":"6–7","value":"6_7"},{"label":"7–8","value":"7_8"},{"label":"8+","value":"8_plus"}],"required":true},{"name":"med_sleep_difficulties","label":"Do you have any difficulties with sleep? (select all that apply)","type":"checkbox","options":[{"label":"Falling asleep","value":"falling_asleep"},{"label":"Staying asleep","value":"staying_asleep"},{"label":"Early waking","value":"early_waking"},{"label":"Sleep feels unrefreshing","value":"unrefreshed"},{"label":"None","value":"none"}]},{"name":"mf_uses_sleep_aids","label":"Do you use any sleep aids?","type":"radio","options":["Yes","No"],"required":true}]},{"title":"Medicare / IHI Details","subtitle":"Your details are securely stored and only accessible to our clinical team. This information is required under Australian telehealth regulations for prescribing medication.","fields":[{"name":"medicare_or_ihi","label":"Which healthcare identifier do you have?","type":"radio","options":[{"label":"Medicare","value":"medicare"},{"label":"IHI","value":"ihi"}],"required":true},{"name":"medicarenumber","label":"Medicare Card Number","type":"text","required":true,"showIf":{"field":"medicare_or_ihi","value":"medicare"}},{"name":"medicarereference","label":"IRN (Reference Number)","type":"text","required":true,"showIf":{"field":"medicare_or_ihi","value":"medicare"}},{"name":"medicareexpiry","label":"Expiry Date","type":"date","required":true,"showIf":{"field":"medicare_or_ihi","value":"medicare"}},{"name":"ihi_number","label":"IHI Number","type":"text","required":true,"showIf":{"field":"medicare_or_ihi","value":"ihi"}}]},{"title":"Identity & Consent","subtitle":"Last step — verify your identity and confirm consent.","fields":[{"name":"licence_photo_url","label":"Upload a photo of your photo ID (driver's licence or passport)","type":"file","required":true},{"name":"signed_name","label":"Type your full name as your signature","type":"text","required":true},{"name":"agreed_to_terms","label":"Consent","type":"checkbox","options":[{"label":"I confirm the information provided is accurate, and I consent to a telehealth consultation with a Modern Female doctor.","value":"true"}]}]}]

Recovery Assessment

A few quick questions so our doctors can tailor your plan.

Step 1 of

Thanks! Your assessment is in. Our doctors will review it and, once approved, your treatment will appear on your Treatments page.

If you don’t see your treatment on the Treatments page, try refreshing after a few moments.

Complete this step to continue.

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(select all that apply)","type":"checkbox","options":["Strength / Resistance","Cardio","Flexibility / Mobility","Mixed / Functional"]},{"name":"med_work_activity","label":"How active are you at work?","type":"radio","options":[{"label":"Sedentary","value":"sedentary"},{"label":"Lightly active","value":"lightly_active"},{"label":"Moderately active","value":"moderately_active"},{"label":"Highly physical","value":"highly_physical"}],"required":true}]},{"title":"Sleep & Recovery","subtitle":"How you're sleeping.","fields":[{"name":"med_sleep_hours","label":"How many hours do you sleep per night?","type":"radio","options":[{"label":"<5","value":"under_5"},{"label":"5–6","value":"5_6"},{"label":"6–7","value":"6_7"},{"label":"7–8","value":"7_8"},{"label":"8+","value":"8_plus"}],"required":true},{"name":"med_sleep_difficulties","label":"Do you have any difficulties with sleep? (select all that apply)","type":"checkbox","options":[{"label":"Falling asleep","value":"falling_asleep"},{"label":"Staying asleep","value":"staying_asleep"},{"label":"Early waking","value":"early_waking"},{"label":"Sleep feels unrefreshing","value":"unrefreshed"},{"label":"None","value":"none"}]},{"name":"mf_uses_sleep_aids","label":"Do you use any sleep aids?","type":"radio","options":["Yes","No"],"required":true}]},{"title":"Medicare / IHI Details","subtitle":"Your details are securely stored and only accessible to our clinical team. 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Anti-Ageing Assessment

A few quick questions so our doctors can tailor your plan.

Step 1 of

Thanks! Your assessment is in. Our doctors will review it and, once approved, your treatment will appear on your Treatments page.

If you don’t see your treatment on the Treatments page, try refreshing after a few moments.

Complete this step to continue.

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(select all that apply)","type":"checkbox","options":["Enhanced energy","Visible body composition changes","Better sleep","Faster recovery from training","Improved mental clarity","Reduced pain / inflammation"]}]},{"title":"Lifestyle","subtitle":"A few quick lifestyle questions.","fields":[{"name":"med_smoking","label":"Do you smoke or vape?","type":"radio","options":[{"label":"No","value":"no"},{"label":"Yes","value":"yes"},{"label":"Former smoker/vaper","value":"former"}],"required":true},{"name":"med_alcohol","label":"Do you consume alcohol?","type":"radio","options":[{"label":"No","value":"no"},{"label":"Yes","value":"yes"}],"required":true},{"name":"med_alcohol_frequency","label":"How many standard drinks per week?","type":"radio","options":[{"label":"1–3","value":"1_3"},{"label":"4–7","value":"4_7"},{"label":"8–14","value":"8_14"},{"label":"15+","value":"15_plus"}],"showIf":{"field":"med_alcohol","value":"yes"}},{"name":"mf_recreational_drugs","label":"Do you use any recreational drugs?","type":"radio","options":["Yes","No"],"required":true}]},{"title":"Activity & Exercise","subtitle":"How you move day to day.","fields":[{"name":"med_exercise_frequency","label":"How often do you exercise?","type":"radio","options":[{"label":"None","value":"none"},{"label":"1–2 sessions/week","value":"1_2"},{"label":"3–4 sessions/week","value":"3_4"},{"label":"5+ sessions/week","value":"5_plus"}],"required":true},{"name":"mf_exercise_types","label":"What types of exercise do you do? 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(select all that apply)","type":"checkbox","options":[{"label":"Falling asleep","value":"falling_asleep"},{"label":"Staying asleep","value":"staying_asleep"},{"label":"Early waking","value":"early_waking"},{"label":"Sleep feels unrefreshing","value":"unrefreshed"},{"label":"None","value":"none"}]},{"name":"mf_uses_sleep_aids","label":"Do you use any sleep aids?","type":"radio","options":["Yes","No"],"required":true}]},{"title":"Medicare / IHI Details","subtitle":"Your details are securely stored and only accessible to our clinical team. This information is required under Australian telehealth regulations for prescribing medication.","fields":[{"name":"medicare_or_ihi","label":"Which healthcare identifier do you have?","type":"radio","options":[{"label":"Medicare","value":"medicare"},{"label":"IHI","value":"ihi"}],"required":true},{"name":"medicarenumber","label":"Medicare Card Number","type":"text","required":true,"showIf":{"field":"medicare_or_ihi","value":"medicare"}},{"name":"medicarereference","label":"IRN (Reference Number)","type":"text","required":true,"showIf":{"field":"medicare_or_ihi","value":"medicare"}},{"name":"medicareexpiry","label":"Expiry Date","type":"date","required":true,"showIf":{"field":"medicare_or_ihi","value":"medicare"}},{"name":"ihi_number","label":"IHI Number","type":"text","required":true,"showIf":{"field":"medicare_or_ihi","value":"ihi"}}]},{"title":"Identity & Consent","subtitle":"Last step — verify your identity and confirm consent.","fields":[{"name":"licence_photo_url","label":"Upload a photo of your photo ID (driver's licence or passport)","type":"file","required":true},{"name":"signed_name","label":"Type your full name as your signature","type":"text","required":true},{"name":"agreed_to_terms","label":"Consent","type":"checkbox","options":[{"label":"I confirm the information provided is accurate, and I consent to a telehealth consultation with a Modern Female doctor.","value":"true"}]}]}]