Briefly describe your eating habits (ex. breakfast, lunch, dinner, snacking, intermittent fasting, etc.):
Briefly describe daily water, soda, & coffee consumption:
If you have siblings, do they have any health conditions:
If you have grandparents, do they have any health conditions:
Female Health History
Please explain any "YES" answers
Date of last pap smear & mammogram (explain positive findings if any):