Wellness Plan Generator

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Disclaimer & Terms & Conditions* This field is required.Please provide the correct email, so that you can receive your report. Use your first name only, nickname or alias to ensure that your privacy is protected. This report is for your eyes only, no one will have access to your report besides you when you receive it via email. AI is used to generate this report, so DO NOT USE your last name to ensure your information remains anonymous.

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Email* This field is required.Please provide the address you'd like to receive your results

example@example.com

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What is your first name, age and gender?* This field is required.(e.g. My name is Paul and I'm a 46 y/o man.)

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Which of these best describes your main objective?* This field is required.(e.g., weight loss, performance, hormone balance, sexual health, longevity, energy, better skin, etc.)

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Are there any secondary goals or additional objectives you’d like to pursue?* This field is required.(E.g., better skin, stronger relationships, improved mental focus, etc.)

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What specific results do you want to achieve?* This field is required.(e.g., increase muscle mass, improve mental clarity, boost libido, etc.)

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What is your current height and weight, and do you have any additional biometric information to share?* This field is required.(e.g., body fat percentage, waist circumference, recent hormone levels)

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Have you been diagnosed with any medical conditions or do you have any known allergies or sensitivities?* This field is required.(e.g., hypertension, diabetes)

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Have you had lab work done in the last 6 months? If so, please share any notable results.* This field is required.(e.g., cholesterol levels, hormone panels, etc.)

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Are you currently taking any prescribed medications?* This field is required.

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What was your most recent blood pressure and pulse reading?

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Have you ever used medical wellness or peptide therapies before? If so, which ones, and if not, are you open to exploring these?* This field is required.(e.g., GLP-1 medications, testosterone therapy, PT-141)

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How would you describe your typical daily eating habits? For instance, do you follow a particular diet plan, or have any dietary restrictions?* This field is required.

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What type of physical activity or exercise do you currently engage in, and how often each week?* This field is required.

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On average, how many hours do you sleep each night? Do you experience any difficulties falling or staying asleep?* This field is required.

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How do you approach or maintain your current sleep routine, and are you open to additional stress-management practices?* This field is required. (like mindfulness or journaling)

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How do you typically manage stress or maintain your mental health?* This field is required.(Meditation, journaling, counseling, etc.)

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Do you currently take any supplements or additional vitamins? If so, please list them, and if not, are there any you’re considering?* This field is required.(e.g., fish oil, vitamin D, protein shakes)

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Do you have any additional dietary preferences or restrictions, or specific meal structures you’d prefer?* This field is required. (e.g., vegetarian, low-carb, food allergies)

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Are you currently in a committed romantic relationship, and if so, how you feel it effects your overall health and well-being?* This field is required.(positively, negatively, etc.)

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How satisfied are you with the level of intimacy you experience overall?* This field is required.

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How often would you like check-ins (weekly, bi-weekly, monthly), and do you use any tracking methods or apps?* This field is required.(e.g., fitness trackers, food logs)

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How long do you plan to commit to your wellness approach?* This field is required.(3 months, 6 months, indefinitely)

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Are there any specific obstacles or challenges that might affect your commitment?* This field is required. (e.g., work travel, financial constraints, motivation)