Detective Health
Methylation Profile Plasma & MTHFR · Client Intake Form

Methylation & MTHFR Intake Form

This form takes approximately 15–20 minutes. It collects the clinical history, medication exposures, dietary patterns, and prior testing results needed to interpret your Methylation Profile Plasma in full context. Please complete it before your blood draw appointment.

01 Personal Details
Basic information for matching your form to your test results
02 Prior Genetic Testing
MTHFR variants and other SNP results you already have
03 Medications & Supplements
Several medications and supplements directly deplete methylation cofactors or alter the cycle
Several common medications deplete methylation cofactors or directly impair the cycle. This section is not about judging medication use — it is essential clinical context for interpreting your results accurately.
04 Dietary Folate & Fortified Food Exposure
Your dietary folate sources and exposure to fortified foods — directly relevant to your results
05 Reproductive & Family History
Methylation has strong implications for reproductive health and runs in families
06 Current Symptom Pattern
Rate each symptom: 0 = absent, 1 = mild/occasional, 2 = significant/frequent
Depression / low mood
Anxiety / irritability
Brain fog / poor concentration
Memory problems
Fatigue (not relieved by rest)
Poor sleep / insomnia
Tingling / numbness (hands, feet)
Headaches / migraines
Heart palpitations
Poor circulation / cold extremities
Oestrogen dominance symptoms
PMS / hormonal mood changes
Histamine intolerance / reactions
Chemical / environmental sensitivity
Joint pain / inflammation
Skin conditions (eczema, psoriasis)
07 Previous Functional Testing
Results from prior functional or standard blood tests relevant to methylation

Ready to submit?

Review your answers above. Once submitted, Stephen will read this form before your blood draw appointment and results consultation. Nothing is automated.

This form is confidential and read personally by Stephen Duncan FDN-P. It is not a medical assessment and does not constitute a diagnosis. Functional testing is investigative, not diagnostic. If you have urgent health concerns, please contact your GP.