About you

Let's start with the basics.

This helps us match you to the right clinician and care.

Full name Date of birth Email Home address

I identify as

Is this the same as your sex registered at birth?

Ethnicity

Select the option that best describes you.

White

Mixed

Asian or Asian British

Black, Black British, Caribbean or African

Other

Past medical history

Have you ever been diagnosed with a medical condition?

Include anything you see your doctor about regularly, or any long-term condition. Select all that apply.

Have you ever been diagnosed with pancreatitis?

Social history

A little about your day-to-day.

Do you have any care needs?

Select all that apply.

Do you smoke or vape?

How much alcohol do you drink in a typical month?

How much do you exercise?

Medications & surgery

Do you take any medications?

Select all that apply, including anything bought over the counter.

Have you ever had surgery?

Select all that apply.

Family history

Does anything run in your family?

Any cancers or immune conditions among close relatives. Select all that apply.

Just making sure we haven't missed anything.

Please confirm the following apply to you.

Your goals

What are you looking for through Allora?

Select everything that applies - there are no wrong answers.

Are you using, or have you ever used, peptides?

Consent

How we'll use your information.

Your privacy matters. You're in control of your data, and you can withdraw at any time.

Please confirm the required consent so a clinician can review your information.

Something went wrong sending your answers. Please check your connection and try again.

All done - thank you.

One of our clinicians will review your information and be in touch about eligibility, acceptance and your next steps. Keep an eye on your inbox - there's nothing more you need to do right now.

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