Bloodwork and biomarkers
Full panel ordered as part of the day.
- Advanced lipid metrics
- Metabolic metrics above standard panels
- Hormone markers when clinically relevant
- Inflammation and recovery markers
Services
What happens inside the practice.
Everyone starts with a deep first review. We look at your health history, blood work, fitness, strength, sleep, body composition, medications, family history, and goals. Then you get a written plan and a visit to walk through what it means.
The pathway
How you join the practice, in four steps.
The first review is the same for everyone. After that, the recommendation is based on your results, your goals, and how much follow-up would actually help.
Step 1
Apply
A short form helps make sure the practice is likely to be useful before anyone commits.
Step 2
Deep Review
A thorough first look at your records, goals, blood work, fitness, body composition, strength, sleep, and risks.
Step 3
Clear Plan
You get a written report and a visit to review what matters, what can wait, and what to do first.
Step 4
Next Step
Some people need a focused plan only. Others benefit from yearly check-ins or ongoing physician follow-up.
The Deep Review
The first step is a full picture, not a quick checkup.
The goal is to understand the person behind the numbers. We look for patterns, tradeoffs, and missed signals, then turn them into a plan that can actually be followed.
Health and training history
What you have tried, what has changed, what you want, and what has been getting in the way.
Prior records review
Past labs, imaging, wearable trends, medications, and notes reviewed together.
Smart testing plan
The labs and performance tests worth doing now — advanced lipid metrics, metabolic metrics above standard panels, fitness testing, body composition. No testing for testing's sake.
Body and movement review
Hands-on physical exam, MSK functional battery (single-leg balance, hinge mechanics, push and pull strength, grip strength), gait observation, training-movement read. In-person when geography allows.
Doctor review of all findings
The information is interpreted in one place by the physician responsible for the plan.
Main issue identified
The report names the area most likely limiting your health, fitness, or long-term capacity.
Written plan
A written report covering clinical priorities, the initial action plan, retest schedule, and what triggers a change. Yours to keep, revisit, and share with other clinicians if needed.
Results review consultation
The report is walked through with you so the plan is understood, not just delivered.
First action plan
What to do first, what to monitor, and what would trigger a change.
Referral recommendations
When another specialist should be involved, and why.
Follow-up recommendation
Whether focused follow-up, annual reassessment, or ongoing care makes the most sense.
The Annual Comprehensive Day
Three to four hours, in person, once a year.
The annual day is the only required in-person visit. The rest of the relationship runs largely on telehealth, with the option of in-person if you live close or prefer it. Here is what the day contains.
In-person measurements
The data that has to be captured in a clinic, not from a wearable. Tests run on-site or coordinated same-day at a partner facility.
- VO₂ max and lactate threshold — the aerobic ceiling and the pace your body can sustain without breaking down energy systems
- Resting metabolic rate (RMR) — resting caloric burn and substrate utilization (fat vs. carbohydrate at rest)
- DEXA body composition — visceral fat, lean mass, bone density
Physical examination and functional assessment
Hands-on, in the room.
- Hands-on physical exam (cardiovascular, MSK, neurologic where indicated)
- Full MSK functional battery (single-leg balance, hinge mechanics, push and pull strength, grip strength)
- Gait observation
- Training-movement read
The walkthrough and forward plan
Where the day pays off.
- Year-in-review using the prior 12 months of data
- Cancer screening review — gap analysis, what's due
- 12-month forward goal-setting
- Updated written report at conclusion
Ongoing care
If continued care makes sense, the same physician keeps the picture connected.
Some people need one focused plan. Others benefit from regular follow-up because their risk, training load, symptoms, or goals are changing. Ongoing care runs at three time-scales, each feeding the next.
Once a year
Annual deep work
The full physical layer — exam, movement battery, in-person testing — then a walk-through of the year's data. The new plan is written from there.
- Annual Comprehensive Day (in-person, 3–4 hours)
- Annual Goal-Setting Visit (telehealth, 60 minutes, separate from clinical reviews)
- Annual Updated Arc Report (physical, premium, archival)
Four times a year
Quarterly judgment
Tests ordered weeks ahead so the visit time is spent on decisions, not on reading numbers for the first time.
- Quarterly Arc-Review Visit (telehealth, 60–90 minutes)
- Pre-visit labs and tests ordered 3–4 weeks ahead; results posted to file 1–2 weeks before visit
- Pre-visit Quarterly Written Progress Note (delivered 48 hours ahead)
- Post-visit updated note within 48 hours
Year-round
Continuous monitoring
Every lab, wearable trend, and outside test integrates into the longitudinal record. The physician decides what is worth a flag — not the patient.
- Vitals Note (six per year, bimonthly — short written summary of what changed, what's being watched, what requires action)
- Personalized Literature Surveillance (quarterly — physician-curated digest of new clinical and performance-medicine literature relevant to your profile)
- Continuous Biomarker Surveillance — every lab result, wearable trend, and CGM data stream integrated into the longitudinal file
- Wearable + CGM thresholds set by physician; alerts trigger physician review, not patient reaction
Communication and access
How you reach the physician between visits.
The scheduled visits above cover the cadence. Below is how the relationship stays connected between them.
Direct physician messaging
1 business day response window.
Your message reaches Andrew directly. No nurse triage. Every reply is physician-overseen. Average response in practice: 4–8 hours.
Open Afternoon Office Hours
1–5 PM weekdays.
Andrew reserves the afternoon block for patient-initiated touches. Book a 15–30 minute Zoom or phone slot same-day or next-day — no scheduling weeks ahead.
Same-day for urgent in-scope questions
Business hours, within scope.
When something urgent and clinically relevant comes up, the relationship is built to respond same-day. Acute emergencies still go to the ED first; routine acute care still routes elsewhere.
Coverage when the physician is away
Named continuity physician.
Planned absences (vacation, conferences, parental leave) are communicated at least 60 days in advance. A named continuity physician handles messaging response and urgent in-scope questions during the window. Strategic and complex case work holds for Andrew's return.
When a question warrants a deeper conversation than a message can hold, an ad-hoc clinical visit is scheduled within days. No additional fee within scope.
Clinical scope
What you can call the physician for.
Below is what the practice manages day-to-day. Anything outside this scope is triaged — the physician responds, names where to route it, and integrates the result into your longitudinal record.
Cardiometabolic risk
Advanced lipid metrics, metabolic metrics above standard panels, blood pressure, body composition. The full risk picture, interpreted by one physician.
Performance physiology
VO₂ max, lactate threshold, MSK functional battery, training load, recovery, sleep, HRV. The data behind how the body is actually working.
Cancer prevention and screening
Comprehensive screening protocol (colon, prostate, breast, skin, lung where indicated), CAC for vascular calcium, hereditary cancer panels (BRCA, Lynch, others) when family history warrants. Multi-cancer early detection and full-body MRI considered case-by-case, with explicit discussion of test characteristics.
Hormones
TRT decisions and management. Perimenopause and menopause where relevant. Thyroid management within scope.
Medication management
Full prescriptive authority within scope — dosing, refills, titrations. The thing AI cannot do.
Vaccines and travel medicine
Routine adult immunizations, COVID, flu. Pre-trip vaccinations, prophylactic prescriptions, drug interactions, in-trip guidance.
Training-related acute issues
Respiratory illness disrupting training cycles, exercise injury, sport-specific bloodwork, race-week medical preparation.
Specialist coordination
Warm referrals to cardiology, sports medicine, PT, GI, derm, endocrinology. Perioperative management when surgery happens elsewhere. Imaging review and integration.
Family screening cascade
When a hereditary finding emerges, the physician facilitates the discussion and screening pathway for first-degree relatives — at no additional clinical fee.
Off-label and emerging therapeutics
When a new therapy (a GLP-1 for non-diabetes use, a novel lipid-lowering agent, an emerging longevity drug) becomes clinically defensible for your profile, it's evaluated and discussed. You don't have to find out from a podcast.
The triage rule
Anything outside this scope still gets a response. The physician triages — names where to route it (urgent care, PCP, specialist), and integrates the result into your longitudinal record. You never wait on a question for the answer to be "not my scope" with no path forward.
Out of scope
- True acute emergencies. ED first, then notify the practice.
- Routine acute care unrelated to training. Urgent care or your PCP.
- Mental health primary care. Referral list; not in-scope for ongoing management.
- Family-member care. Unless enrolled via the Family Layer.
Scope ladder
Three tiers, plus a family add-on.
The base scope works for most patients. Two additions are available when fit warrants. A spouse or partner can be added at any tier.
Tier A
The base relationship.
The full Vital Capacity scope — Annual Comprehensive Day, quarterly Arc-Reviews, direct messaging, the longitudinal record. You manage your own coach or trainer (or don't have one). Suitable for most patients.
Tier B
Adds coordinated coaching integration.
Tier A in full, plus formal integration with your coach at a partner gym. A HIPAA-compliant communication channel between the physician and your coach. Programming changes that need physician input flow through that channel — not through you as messenger. Constraint authority resolves with the physician.
Tier B+
Adds higher cadence and priority access.
Tier B in full, with tighter cadence — bi-monthly Arc-Review visits (six per year), two Annual Comprehensive Days per year, monthly Vitals Notes. Same-business-day response on in-scope questions. First availability for ad-hoc visits and Annual Day scheduling. Scope does not expand at this tier — cadence and responsiveness do.
Family Layer
Available at any of the tiers above. The Family Layer can extend across a household — a spouse, partner, or multiple family members can each be enrolled at the same tier. Each gets the full corresponding-tier relationship: their own Diagnostic Assessment, their own Annual Comprehensive Day, their own Arc-Reviews, their own longitudinal record. Not a discount, not a shared offering — a full clinical relationship for each person enrolled.
The Performance Arc
A clinical biography, built year over year.
Every visit, every test, every signal — anchored in one document that grows with the relationship. The patient owns it. Portable on request.
Once a year · Physical archive
Annual Updated Arc Report
The year's full clinical narrative — biomarker arcs, training response, evolving priorities, and the trajectory forward. The document you keep for life.
Four times a year
Quarterly Arc-Review Notes
Pre-visit Quarterly Written Progress Note and post-visit updated note. Each quarter's data, decisions, and adjustments captured in writing.
Six times a year · Bimonthly
Vitals Notes
Short written summaries of what changed, what's being watched, and what requires action.
Four times a year · Quarterly
Personalized Literature Surveillance
Physician-curated digest of new clinical and performance-medicine literature relevant to your specific profile.
Year-round
Continuous biomarker and wearable integration
Every lab result, wearable trend, and CGM data stream — integrated into the record between visits.
Refreshed annually
Strategic forecasting
5- and 10-year trajectory projections under current trends and under intervention scenarios.
By Year 10+, the Arc is a decade of integrated physiology in one document — the clearest record anyone will have of how you aged. Portable on request, with continued access if the relationship ends.
What this is not
The practice is intentionally focused.
Clear boundaries make the care easier to trust. Vital Capacity is built to help you understand your health and make better medical decisions, not to sell every wellness product around it.
No supplement store.
Supplements may be discussed when they make sense, but the practice does not sell them.
No daily coaching plans.
This is medical guidance, not a daily workout program, meal plan, or motivation app.
No dashboard without judgment.
More data is not the product. The value is knowing what the data means.
No unlimited growth.
The practice is capped on purpose so the physician can know each patient inside it.
No AI-only product.
There is no AI consult, no AI-tier subscription, no AI longevity product. The physician is the product.
What success feels like
A good fit should be able to say these things.
The goal is not to impress you with complexity. The goal is to make your next health decisions clearer.
- I have a physician who knows my file cold and brings up things I wouldn't have known to ask.
- I have not waited more than a business day for an answer to a clinical question in twelve months.
- Every lab, every scan, every wearable trend I have produced has been seen by my physician.
- I know exactly what is currently the single biggest threat to my long-term capacity, and exactly what we are doing about it.
- I have made better decisions about my body in this year than in any prior year of my life.
- I have an annual report I will keep for the rest of my life.
- Somewhere around month four, I realized this was the most useful clinical relationship I'd ever had.
Start here
Start with a clearer picture.
Take the quiz to see which area may deserve the closest look, or join the email list for updates as founding patients are accepted.