Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Your Test Type *Stress & BurnoutVitalityStengthWomen’s HealthMoonlightDaylightOracardioTria4ADTube Code *the code That it’s on your tube Ex: N1234Time of day when you take your sample30 minutes after waking upin the morningin the afternoonin the eveningbefore going to sleepDate of colection *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Your gender *MaleFemalenon binaryDate of birth *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Height * in cmWeight *in KgMenses Status *FertileFertileMenopause/AndropauseIf fertile, day of the cycle *Hours of sleep per night: *<5 hours<5 hours5-7 hours7-9 hours>9 hoursthe average number of hours of sleep per nighHow is the quality of your sleep: *Very goodVery goodGoodNormalBadVery badthe average quality of sleepHours of sport per week: *nonenone<3 hours3-6 hours>6 hoursHow often do you feel Calm/Peaceful *NeverNeverOccasionallyAbout Half of the TimeMost of the TimeAlwaysHow often do you feel Energetic *NeverNeverOccasionallyAbout Half of the TimeMost of the TimeAlwaysHow often do you feel Gloomy *NeverNeverOccasionallyAbout Half of the TimeMost of the TimeAlwaysHow often do you feel Angry *NeverNeverOccasionallyAbout Half of the TimeMost of the TimeAlwaysDo you have poor appetite or overeat *Not at allNot at allSome daysEvery second dayNearly every dayStress Percived Every day Selected Value: 0current hormonal or non-hormonal treatments *noneif you are currently taking any medical or non-medical treatments, please let us know. Any treatment, even natural ones, may influence your hormone results.current or past illnesses *noneif you are currently ill or have had illnesses in the past other than the common ones, it is important to let us know so that we can give you the most accurate results possible.Fitstrip-NONitric Oxide poor dietNitric Oxide poor dietNO rich diet/Low probiotic for NONO rich diet/High probiotic for NOFitstrip-Uric Acid=< 1.5=< 1.52.55.07.0=>10.0comments *noneat this point you can provide us with any information not yet mentioned that you consider relevant so that the VitalizeDx team can deliver a personalized report that takes into consideration as much as possible of your personal data.Chose the language of your report *FrancaisItalianoDeutschEnglishSubmit
