The BLISS Method

The BLISS Method

Let’s Build Your Wellness Blueprint – Apply for The Bliss Method! This is a high-touch, science-backed wellness program designed to heal and reset your metabolism, optimize your hormones, and boost longevity through precision medicine. Please complete this short application so we can determine if this program is the right fit for you.
Name

First NameLast Name
Date

MonthDayYear
Date
Email
example@example.com
Age
Ex:23
Gender
Goals & Readiness
What is your primary goal? (Select all that apply)

Sustainable Weight LossLongevity/Anti-AgingOptimizing HormonesStrength Training/Muscle BuildingGut HealthInflammation Control
What have you tried before? (Select all that apply)

Vigorous Cardio ExerciseHormone TherapyKeto DietGut Health TestingCalories in/Calories outStrength/HIIT TrainingCarnivore DietCrash DietsWeight Loss Medications (other than Ozempic/Mounjaro. ie: Phentermine)
Are you pregnant?

YesNoN/A
Are you nursing?

YesNo
Are you struggling and/or not feeling well regularly?

YesNo
What is your biggest struggle with health?
How committed are you to making real, lasting changes right now? (Scale of 1-10) 1=Just exploring options 10=Ready to go NOW
Are you currently on or have you taken a GLP-1 medication? (Ozempic/Mounjaro)

YesNo, but I'm interestedI prefer a natural approach
Do you have any diagnosed conditions that affect metabolism? (Select all that apply)

PCOSHashimoto's/Thyroid DysfunctionInsulin Resistance/PrediabetesAdrenal DysfunctionNone of the above
Are you currently taking any medications or supplements? Please list below.
Investment Readiness
Are you ready to invest in a high-level health transformation program?

Yes, I'm fully ready to commitMaybe, I need to understand the details firstNo, I'm just gathering information
Which payment structure works best for you?

Pay in Full (Best Value)Monthly Payment PLanNot sure, would love to discuss options
Why do you want to join The Bliss Method NOW? What’s driving you to make this change at this point in your life?
Thank you for taking the time to answer the questions! Once you submit your application, I’ll personally review it and reach out to discuss next steps!
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The BLISS Method

Goals & Readiness

Investment Readiness