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CORTESI LONGEVITY

Comprehensive Metabolic Health Assessment

Confidential Client Information

Birthday
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Primary Objectives

What is your primary reason for seeking health optimization? (Select all that apply)

Current Health Status

Have you experienced any of the following in the past 6 months? (Select all that apply)

Medical History

Metabolic & Lifestyle Assessment

Do you currently track any of the following?
Current dietary approach (Select primary approach)
Have you completed any of the following assessments? (Select all that apply)

Cortesi Longevity Policies

Consultation Structure

Your initial Private Health Strategy Consultation is designed to explore your current health status, lifestyle and long-term wellbeing goals, tailored to your physiology and performance requirements.


This stage serves as a strategic entry point into the Cortesi Longevity Protocol and ensures that any future recommendations are aligned with your individual priorities and health objectives.


A follow-up Longevity and Metabolic Intelligence Assessment is strategically scheduled to provide a deeper understanding of an individual's metabolic health, biological aging profile, nutritional status, optimize adherence, and adjust protocols based on real-time biomarker feedback.

Cancellation & Rescheduling Policy

We maintain a limited client roster to ensure the highest level of personalized attention and clinical precision.


Cancellations or rescheduling requests must be submitted at least 48 hours in advance.


Appointments cancelled with less than 48 hours' notice will incur the full consultation fee.


This policy ensures we can accommodate clients from our waiting list and maintain the quality and integrity of our service.

Confidentiality & Data Protection

All information provided is held in strict confidence and compliance with UK and EU GDPR regulations. Your health data will never be shared with third parties without your explicit written consent.

Client Declaration & Consent

By submitting this form, I confirm that:

✔ All information provided is accurate and complete to the best of my knowledge

✔ I will notify Cortesi Longevity Medicine in writing of any changes to my health status

✔ I have read and accept the cancellation policy outlined above

✔ I understand that nutritional guidance does not replace medical treatment and will consult my physician for any medical concerns

✔ I consent to receive appointment reminders, educational content, and service updates from Cortesi Longevity Medicine via email, SMS, or post

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