Lifestyle. Health. Science.
Clinical Tools
Ready-to-use intake forms, patient questionnaires, clinical matrices and practitioner worksheets — designed for functional medicine practice.
These tools are designed to support clinical assessment and patient communication. They do not replace clinical judgment. All questionnaires reference validated instruments where applicable — scoring guides are included in each download.
Patient Intake & Assessment
Intake Form
Comprehensive Functional Medicine Intake Questionnaire
Multi-system symptom inventory, timeline, and lifestyle history. Covers 12 body systems with severity scoring. Available in PDF and editable Word format.
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Timeline Tool
Functional Medicine Personal Health Timeline
Patient-facing timeline worksheet mapping significant life events, illnesses, exposures, and symptom onset chronologically. Supports the Functional Medicine Matrix approach.
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Matrix
Functional Medicine Matrix — Clinical Worksheet
Practitioner-facing IFM matrix template for organising patient data across antecedents, triggers, mediators, and the seven physiological nodes. Print-ready A3 format.
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Sleep Assessment
Validated Questionnaire
Pittsburgh Sleep Quality Index (PSQI)
Full 19-item validated PSQI questionnaire with scoring guide and clinical interpretation notes. Assesses sleep quality and disturbances over the past month.
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Screening Tool
STOP-BANG Obstructive Sleep Apnoea Screening
Validated 8-item OSA screening questionnaire with risk stratification guide and referral pathway recommendations for primary care and lifestyle medicine.
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Patient Handout
Sleep Hygiene Guide — Patient Handout
Evidence-based, practitioner-reviewed patient handout on sleep hygiene. Covers circadian rhythm, sleep environment, evening routine, and stimulant timing. Branded for your practice.
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Metabolic & Hormonal Assessment
Testing Guide
Functional Lab Interpretation Guide — Metabolic Panel
Optimal vs. standard reference ranges for key metabolic markers — fasting insulin, HbA1c, triglycerides, LDL particle size, ferritin, and inflammatory markers. With clinical action thresholds.
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Patient Questionnaire
Menopause Symptom Severity Tracker
Validated symptom tracker for monitoring menopausal symptoms across physical, psychological, and vasomotor domains — with treatment response monitoring grid.
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Worksheet
Food & Symptom Diary — 14-Day Template
14-day food and symptom diary with gut, energy, mood, and skin columns. Designed for elimination diet support and identifying dietary triggers in clinical practice.
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Patient Communication
Patient Handout
"What is Functional Medicine?" — Patient Explainer
Clear, jargon-free one-page explainer for new patients. Covers the systems-biology approach, what to expect from a consultation, and how it differs from conventional care.
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Consent Template
Informed Consent Template — Functional Medicine Consultation
GDPR-compliant informed consent template covering scope of practice, data use, limitations of functional medicine, and referral pathways. Reviewed for Irish regulatory context.
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Reference Card
Supplement Safety Quick Reference — Practitioner Card
Concise reference card covering key drug-nutrient and supplement-drug interactions for the most commonly used functional medicine supplements. Evidence-graded.
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International Organisational Member
FMC Ireland is proud to be an International Organisational Member of the Institute for Functional Medicine
Visit ifm.org →
FMC Ireland is proud to be an International Organisational Member of the Institute for Functional Medicine
Visit ifm.org →