PRO FOUNDATIONS

Initial Assessment & Program Establishment

Performance. Recovery. Optimization.

Welcome to PRO Foundations. This initial assessment establishes your starting point and helps your PRO provider develop an individualized 90-day plan based on your goals, body composition, lifestyle, nutrition, activity, recovery, and other relevant health information.

Please complete this questionnaire and provide the requested baseline Hume data before your initial PRO Foundations appointment.

PART 1 — PATIENT INFORMATION

Name

Date of Birth

Date

What prompted you to begin PRO Foundations?

What are you primarily hoping to improve?

Weight loss Reduce body fat Preserve muscle Increase muscle Body recomposition Improve metabolic health Improve nutrition Improve exercise performance Improve recovery Improve sleep Improve energy Improve general health Establish better health habits Monitor body composition Optimize supplementation

Other goal

PART 2 — YOUR 90-DAY GOALS

Your goals do not have to be based only on body weight. Consider body composition, strength, energy, nutrition, sleep, activity, recovery, and overall health.

What is your #1 goal for the next 90 days?

What would make this program successful for you?

Current weight, if known (lb)

Goal weight, if applicable (lb)

Current body-fat %, if known

Goal body-fat %, if applicable

How important is achieving your current health/body-composition goals? (1–10)

How confident are you that you can make the changes necessary to reach your goals? (1–10)

PART 3 — HUME EQUIPMENT SETUP

PRO Foundations uses Hume data to monitor changes in body composition, activity, sleep, recovery, and other health trends throughout your 90-day program.

Do you have your Hume Body Pod?

Is your Hume Body Pod connected to the Hume app?

Have you completed your initial Body Pod measurement?

Do you have your Hume Band?

Is your Hume Band connected and syncing with the Hume app?

Are you currently wearing your Hume Band consistently?

Before your initial assessment, complete a current Body Pod measurement and sync your Hume Band with the Hume app.

If your Hume devices are new and do not yet have meaningful trend data, submit the available baseline screens now. Your trend data will become more useful during your 30-, 60-, and 90-day assessments.

PART 4 — BASELINE HUME DATA

Please provide your available baseline Hume screens. These measurements will be used as your starting point for comparison during your 30-, 60-, and 90-day assessments.

1. Current Body Composition

Upload your most recent Body Pod measurement showing as many available metrics as possible, including weight, body-fat %, fat mass, muscle/lean mass, visceral fat, and hydration.

2. Body Composition Overview / Starting Screen

Upload the Body Composition overview or trend screen currently available in your Hume app.

3. Activity

If available, upload the screen showing your current activity, daily steps, or activity trend.

4. Sleep

If available, upload your current Sleep screen.

5. Recovery / HRV

If available, upload your current Recovery / Readiness / HRV screen.

6. Heart / Cardiovascular

If available, upload the screen showing resting heart rate and other cardiovascular or fitness metrics.

If your total screenshot file size is too large for email submission, use the PDF + OnPatient option at the end of this form.

PART 5 — NUTRITION BASELINE

How would you rate your current nutrition consistency? (1–10)

How many meals do you typically eat per day?

Are you intentionally prioritizing protein?

Estimated daily protein intake, if known (grams/day)

Do you feel you currently consume enough protein to support your goals?

Approximate water intake (oz/day)

Current nutrition challenges

Protein intake Meal preparation Portion control Snacking Food cravings Emotional/stress eating Nighttime eating Eating out Work schedule Travel Hydration Digestion Meal timing Staying consistent None

Current digestive concerns

Constipation Diarrhea Bloating Reflux/heartburn Nausea Abdominal discomfort None

Describe a typical day of eating, including meals, snacks, and beverages.

PART 6 — EXERCISE & ACTIVITY BASELINE

Strength training days per week

Cardiovascular exercise days per week

Describe your current exercise routine

How would you rate your current exercise/activity consistency? (1–10)

Do pain, injury, or physical limitations currently interfere with exercise or activity?

Please explain

PART 7 — SLEEP, ENERGY & RECOVERY BASELINE

Average sleep per night

Sleep quality (1–10)

Daily energy (1–10)

Recovery (1–10)

Current stress (1–10)

Current sleep concerns

Difficulty falling asleep Waking during the night Waking too early Not feeling rested Inconsistent sleep schedule Insufficient sleep time No significant concerns

PART 8 — CURRENT SUPPLEMENTS

Are you currently taking vitamins, supplements, or nutritional products?

List your current supplements and approximate doses if known.

How consistently do you take your current supplements?

What would you most like supplementation to help you improve?

PART 9 — WEIGHT / METABOLIC MEDICATIONS

Are you currently using medication for weight or metabolic management?

Medication

Current dose

How long have you been using it?

How effective has appetite control been? (1–10)

Current side effects or concerns

Nausea Vomiting Constipation Diarrhea Reflux Abdominal discomfort Fatigue Excessively low appetite Difficulty consuming enough protein Difficulty staying hydrated No significant side effects

PART 10 — PEPTIDE / OPTIMIZATION THERAPY

Are you currently using peptide therapy?

Current peptide(s)

What are you primarily using peptide therapy for?

Have you noticed any benefits?

Any side effects or concerns?

PART 11 — HEALTH & MEDICAL CHANGES

This section helps identify health factors that may affect your nutrition, activity, body composition, or PRO Foundations plan.

Have you had any significant health changes during the last 6 months?

Please explain

Are there any medical conditions, medications, injuries, or other health considerations that you believe may affect your program?

Have you completed blood work within the last 6 months?

Approximate lab date

Were you told anything was abnormal or significantly changed?

Comments

Optional Laboratory Results

Upload recent laboratory results if they are not already available to your PRO provider.

PART 12 — CURRENT BARRIERS

What factors currently make it more difficult to reach your goals?

Nutrition Protein intake Exercise consistency Lack of time Work schedule Travel Family responsibilities Stress Poor sleep Injury/pain Low energy Motivation Food cravings Medication side effects Cost No significant barriers

Other barrier

What do you believe would help you be most successful during the next 90 days?

PART 13 — ESTABLISHING YOUR PRO FOUNDATIONS PLAN

Select the three areas you believe should receive the highest priority during your first 30 days.

Weight loss Reduce body fat Preserve muscle/lean mass Increase muscle Increase protein intake Improve nutrition Increase strength training Increase cardiovascular exercise Increase daily activity/steps Improve sleep Improve recovery Improve hydration Improve energy Establish supplement routine Medication management Peptide management Complete laboratory testing Establish consistent Hume monitoring

Other priority

Is there anything else you want your PRO provider to know before establishing your initial plan?

FINAL CHECKLIST

Before submitting your initial assessment, confirm that you have completed the available setup steps.

Questionnaire completed Hume Body Pod connected Initial Body Pod measurement completed Hume Band connected Hume Band synced Current Body Composition screenshot prepared Available Hume baseline screenshots prepared Recent labs prepared if applicable

SUBMIT YOUR INITIAL ASSESSMENT

Your PRO Foundations initial assessment includes your completed questionnaire plus your available baseline Hume screenshots and any applicable supporting documents.

Option 1 — Submit by Email

For convenience, you may submit this questionnaire and the files selected above electronically to the PRO Sports Medicine team at admin@arizonasportsmed.com for review before your appointment.

I understand that I am choosing to submit the information and selected files through email rather than through my OnPatient portal.

Option 2 — Download PDF + OnPatient

If you prefer not to submit your health information through email, download a PDF copy of your completed questionnaire and upload it through your OnPatient portal.

The downloaded PDF contains your questionnaire responses only.

Your Hume screenshots and laboratory files are not included in the PDF.

After saving the questionnaire PDF, upload the PDF and each original Hume screenshot separately through your OnPatient portal.

Files to Upload Separately With Your PDF in OnPatient

Current Body Composition screenshot
Body Composition overview / starting screen
Activity screen, if available
Sleep screen, if available
Recovery / HRV screen, if available
Heart / cardiovascular screen, if available
Recent laboratory results, if applicable

Please upload the original screenshots individually. Do not combine the screenshots into the questionnaire PDF.