Patient Portal

Begin your journey to whole‑self wellness.

Welcome to the Sure Success Wellness patient portal. Complete your intake forms and surveys before your visit so we can give you the personalized, attentive care you deserve.

SSWEST. WELLNESS
10+

Years guiding patients to their healthiest selves

100%

Confidential — your information stays with our team

5★

Personalized concierge wellness experience

24h

Average response to portal submissions

For New & Returning Patients

Patient Intake Forms

Choose the forms that apply to your visit. Your responses are sent securely to Dr. Thomas's care team.

👤
Required for first visit

New Patient Registration

Demographics, contact information, insurance, emergency contact and consent — the basics we need on file.

Begin form →
📝
Required for first visit

Comprehensive Medical History

Past conditions, surgeries, medications, allergies, family history, and lifestyle context.

Begin form →
⚖️
Metabolic program

Weight Loss / Metabolic Intake

Weight history, diet, exercise, body measurements, and GLP‑1 readiness assessment.

Begin form →
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Hormone & wellness program

Hormone & Wellness Intake

Symptoms, energy, sleep, mood, libido and reproductive history for hormone optimization.

Begin form →
Recurring Check‑Ins & Feedback

Patient Surveys

Help us track your progress and refine your care plan. These short surveys take 3–8 minutes each.

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Progress tracking

Symptom Check‑In

A quick look at how you're feeling between visits — symptoms, severity, and what's improving.

Take survey →
🌿
Whole‑self assessment

Wellness Lifestyle Assessment

Sleep, stress, nutrition, movement, and mental health — the foundations of long‑term vitality.

Take survey →
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After virtual visits

Telehealth Follow‑Up

Confirm the visit went smoothly, note any technical issues, and tell us how you're doing now.

Take survey →
Your feedback

Patient Satisfaction

Rate your visit, our staff and the care you received. Your candor helps us improve.

Take survey →
♀️
Specialized assessment

Female Hormone Assessment

Menstrual, perimenopause, menopause and hormonal symptom inventory for women.

Take survey →
♂️
Specialized assessment

Male Hormone Assessment

Testosterone, energy, libido, mood and andropause symptom inventory for men.

Take survey →
About Sure Success Wellness

Personalized care for your whole self.

Sure Success Wellness, founded by Dr. Sheila Thomas, is a concierge wellness practice committed to helping you reclaim your vitality. We blend evidence‑based medicine with a holistic, compassionate approach — treating the whole person, not just symptoms.

Whether you're navigating weight management, hormone changes, fatigue, or simply seeking a new baseline of wellness, our team partners with you at every step. Your portal submissions go directly to Dr. Thomas's clinical team.

Contact the Practice

Why patients choose us

  • Concierge access to Dr. Thomas and her team
  • Comprehensive metabolic and hormone optimization
  • GLP‑1 medical weight management programs
  • Telehealth and in‑person visits to fit your life
  • Whole‑self assessments — body, mind, and lifestyle
Get in Touch

Questions about your forms?

Email Dr. Thomas's team directly — we typically respond within one business day.

success@suresuccesswellness.com

Intake Form

New Patient Registration

Welcome! Please complete this short registration so we have your basic information on file. Estimated time: 4 minutes.

🔒 All information you submit is sent directly to Dr. Thomas's secure email. We do not store your data on this site.
Personal Information
Contact
Emergency Contact
Insurance & Payment

Please bring your physical insurance card to your first visit. Do not enter sensitive ID numbers here if you'd prefer to share them in person.

Reason for Visit
Consent
Intake Form

Comprehensive Medical History

Your medical story helps us care for you safely and personally. Estimated time: 8–10 minutes. Skip anything that doesn't apply.

🔒 Submissions are sent directly to Dr. Thomas's clinical team via secure email.
Identity
Current Medical Conditions
Medications & Supplements
Allergies
Surgical & Hospitalization History
Family History

Indicate any conditions that run in your immediate family (parents, siblings, children).

Lifestyle
Anything else we should know?
Intake Form

Weight Loss & Metabolic Intake

For our metabolic and GLP‑1 weight management programs. Estimated time: 6 minutes.

🔒 Submissions are sent directly to Dr. Thomas's clinical team.
Identity
Current Measurements
Weight History
Eating Patterns
Activity
GLP‑1 Readiness
Goals
Intake Form

Hormone & Wellness Intake

A whole‑self assessment of energy, sleep, mood, libido and reproductive health. Estimated time: 7 minutes.

🔒 Sent directly to Dr. Thomas via secure email.
Identity
Energy & Sleep

Rate from 1 (poor) to 5 (excellent).

Daytime energy
Quality of sleep
Mood & Cognition
Libido & Sexual Health
Libido (sex drive)
Body Composition
Goals & Notes
Survey

Symptom Check‑In

A quick check on how you're doing between visits — 3 minutes.

Identity
How are you feeling overall?
Overall how I feel today (1=worst, 5=best)
Compared to last visit
Symptoms in the past 2 weeks
Treatment & medication
Anything you want to discuss next visit?
Survey

Wellness Lifestyle Assessment

An honest snapshot of the foundations of your health: sleep, stress, food, movement, and mind. 5 minutes.

Identity
Sleep
Sleep quality (1=poor, 5=great)
Stress & Mental Health
Current stress level

In the last 2 weeks, how often have you been bothered by:

Nutrition
Movement
Connection & Joy
Sense of social connection
Sense of purpose / joy
What's the one thing you'd most like to change?
Survey

Telehealth Follow‑Up

Help us improve your virtual visit experience. 3 minutes.

Visit Info
Technology
Visit Quality
Did you feel heard?
Did the visit address your concern?
Since the visit
Anything else?
Survey

Patient Satisfaction

Your honest feedback shapes how we care for you. 4 minutes.

Visit Info
Rate your experience

1 = poor, 5 = excellent

Ease of scheduling
Front desk / staff friendliness
Wait time
Provider listened & explained
Overall care quality
Would you recommend us?
Tell us more
Specialized Assessment

Female Hormone Assessment

A focused inventory of menstrual, perimenopausal, menopausal and hormone‑related symptoms. 6 minutes.

Identity
Menstrual Status
Reproductive History
Symptoms — past 30 days

Check anything you've experienced.

Severity rating
Hot flash severity (0=none, 5=severe)
Mood symptom severity
Sexual / vaginal symptom severity
Hormone Therapy
Goals
Specialized Assessment

Male Hormone Assessment

A focused inventory of testosterone, energy, libido, mood and andropause symptoms. 5 minutes.

Identity
Energy & Vitality
Daytime energy
Strength & stamina vs. 5 yrs ago
Sleep quality
Symptoms — past 30 days
ADAM Screen — quick check

Standard low‑testosterone screening questions.

Medical Background
Hormone Therapy History
Goals