Symptoms Questionnaire

Before you embark on your journey with GCB please fill in this questionnaire. It allows us to make sure you are reaching the correct department or purchasing the correct test or service

The information provided will be private and confidential. It will not be shared with anyone unless requested by you. Please answer the below as honestly as possible by checking the boxes that relate to your experiences or symptoms. A private phone consultation is available at no charge to discuss the below if required.

GC Biosciences have specifically formulated a short but effective questionnaire to determine the best testing methods to fit your symptoms and goals. Please complete the form with as much information and honesty as possible to ensure that our team of experts provide concise feedback to assist you in the best way possible when they review this form.

Take the guesswork out of your medical, training and lifestyle goals by filling in the questionnaire. The best part is that you get to receive a complimentary review from our team of health consultants, scientists, and nutritionists.

If at any point you want more information, or have a question about your application, please do not hesitate to contact us on:

020 7692 8377

    General Information



    Date of birth

    Job role

    Email address



    Vital Statistics

    Height (cm):

    Weight (kg):

    Blood Pressure:


    Body Fat %

    Physical Activity Level

    How many times do you exercise per week?

    Medical History

    Heart attack, bypass, any other coronary surgery?

    Chest discomfort or heart murmurs?

    High blood pressure?

    Ankle swelling?

    Shortness of breath?

    Light headiness or fainting?

    Pulmonary disease (asthma, emphysema, bronchitis)?

    Abnormal blood markers (glucose, triglycerides, cholesterol)?

    Hospitalisation or surgery?

    Diabetes or other metabolic disorder?

    Are you pregnant?

    Any reason why you cannot diet or eat certain foods?

    Is there family history of any disease?

    Are you currently on or previously been on, any medication, if so please state?

    Do you currently have any of the folowing symptoms: continuous cough for alot more than an hour, high temperature (over 38 degrees)

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