P.A.C.E. Comprehensive Patient Intake Questionnaire

We ask at this level of detail (rather than a broad category) because some health risks and screening guidelines differ meaningfully within broader groups — it helps your care team apply the most accurate recommendations for you. If your specific background isn't listed, choose the closest option or "Other."

Sedentary: little to no structured exercise. Light: exercise 1–2 days/week. Moderate: exercise 3–4 days/week. Very active: exercise 5–7 days/week.

This includes whether you're still having regular periods, having irregular periods (perimenopause), or have not had a period for 12+ months (postmenopause).

Both very early (before 12) and later (17+) first periods are linked to future cardiovascular risk — this helps your care team build a complete risk picture.

The cervix is the lower part of the uterus. Some hysterectomies remove it (total) and some don't (partial/supracervical). This determines whether you still need cervical cancer screening.

Type 1: body produces little/no insulin, usually diagnosed young, always requires insulin. Type 2: body doesn't use insulin properly, usually develops in adulthood. Prediabetes: blood sugar higher than normal but not yet diabetes. Insulin resistance: body doesn't respond normally to insulin — often diagnosed before prediabetes/diabetes.

PCOS is a hormonal condition that can cause irregular periods, excess hair growth, or acne.

Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterus, often causing pelvic pain, especially during periods.

"Autoimmune" means the immune system mistakenly attacks the body's own tissue. Examples: Lupus (can affect skin, joints, organs), Rheumatoid Arthritis (joint inflammation), Celiac disease (reaction to gluten damaging the gut), Inflammatory Bowel Disease (chronic gut inflammation).

"Immunosuppressed" means your immune system is weaker than normal — for example, from HIV, an organ transplant, or long-term medications that suppress immune function.

This single question feeds several parts of your assessment (heart, bone, cancer risk, etc.) — no need to repeat it elsewhere in this form.

It's okay if you don't know the exact name or spelling — a rough description (e.g., "a small white blood pressure pill") is still helpful. This will be cross-checked against your medical records.

HPV is a common virus; the vaccine helps protect against strains most linked to cervical cancer.

DES was a medication given to some pregnant women between the 1940s–1970s. Most people will answer "no" or "not sure."

"Live births" means pregnancies that resulted in a baby born alive — this may be lower than your total number of pregnancies if you've had a miscarriage, stillbirth, or termination.

"Gynecologic" refers to the female reproductive system — uterus, ovaries, fallopian tubes, cervix.

A TIA causes temporary stroke-like symptoms that resolve on their own — still important to report.

A lipid panel measures LDL ("bad" cholesterol), HDL ("good" cholesterol), triglycerides, and total cholesterol — a standard blood test. A statin is a medication that lowers cholesterol (common examples: Lipitor, Crestor).

Preeclampsia is a pregnancy complication involving high blood pressure and signs of organ stress (such as protein in the urine) — more specific and serious than general gestational hypertension.

A migraine "aura" is a warning symptom some people get 10–60 minutes before a migraine headache starts — most often seeing flashing lights, zigzag lines, blind spots, or blurry patches in your vision. Some people also feel tingling or numbness. Not everyone with migraines gets this — if you've never noticed it, you likely don't have aura. This distinction matters because migraine with aura carries a meaningfully higher cardiovascular risk than migraine without aura.

This refines the pregnancy/live-birth count you gave earlier — if that count already implies losses, please detail them here.

This is a pregnancy complication where the placenta separates from the uterine wall before delivery, often causing bleeding and pain. It's linked to future cardiovascular risk, so worth noting even if it was many years ago.

IVF (in vitro fertilization) combines eggs and sperm outside the body and transfers the resulting embryo into the uterus. IUI (intrauterine insemination) places sperm directly into the uterus around the time of ovulation. Both are common fertility treatments and are asked about because they're linked to future cardiovascular risk.

Examples: prednisone or similar medications, often prescribed for autoimmune conditions, asthma, or inflammation.

A "serving" is roughly 1 cup of milk/yogurt, 1.5 oz of cheese, or 1 cup of fortified plant milk/juice.

These are inherited genetic syndromes that significantly raise colorectal (and other) cancer risk.

This ancestry is associated with a higher inherited risk of certain cancers, including colorectal cancer.

Ulcerative colitis and Crohn's disease are both forms of inflammatory bowel disease (IBD) — chronic conditions causing inflammation of the digestive tract.

A rare condition causing inflammation and scarring of the bile ducts, sometimes associated with inflammatory bowel disease.

This answer is also referenced by your Cardiovascular assessment (certain treatments affect heart health) — you only need to answer it once, here.

BRCA1/2 are genes that, when mutated, significantly raise breast and ovarian cancer risk.

These are specific biopsy findings that, while not cancer, raise future breast cancer risk.

This is usually noted on your mammogram report as category A–D, or described as "dense"/"not dense."

These symptoms are common during and after menopause and are very treatable.

Postpartum thyroiditis is temporary thyroid inflammation that can occur in the months after childbirth — about 1 in 4 people who have it develop permanent hypothyroidism later.

These medication types are linked to a modestly increased diabetes risk. Bring your medication list if you're not sure — see Question 17.