Let’s get started!

1
What’s motivating you to start?* This field is required.
I want to feel confident and comfortable in my body.
I want to curb my cravings and eat healthier.
I want to move easier and feel lighter.
I want to lower my risk of health issues
I have an upcoming event and want to feel my best.
2
What’s your target weight loss?* This field is required.(Use the slider to choose your goal):
Target KG
0
Up to 5 kg (for a lighter reset)
6–10 kg (for noticeable results)
11–20 kg (for a major change)
Over 20 kg (for a full transformation)
Row 0, Column 0Row 0, Column 1Row 0, Column 2Row 0, Column 3Row 0, Column 4
Target KG
0
Up to 5 kg (for a lighter reset)
6–10 kg (for noticeable results)
11–20 kg (for a major change)
Over 20 kg (for a full transformation)
Row 0, Column 0Row 0, Column 1Row 0, Column 2Row 0, Column 3Row 0, Column 4
3
What is your current weight and height? * This field is required.We’ll calculate your BMI for you.
4
Where do you typically hold most of your weight?* This field is required.
Stomach / Waist
All over
Hips / Thighs
5
On average, how many hours of sleep do you get each night?* This field is required.
More than 9 hours
Less than 7 hours
7–8 hours
It varies / I have trouble sleeping
6
How would you rate your daily stress levels?* This field is required.
Low – I rarely feel stressed
Moderate – I feel stressed a few times a week
High – I feel stressed most of the time
7
What changes are you hoping to experience with this journey?* This field is required.
More energy, better mood and focus
Improved health markers (e.g., blood sugar, cholesterol)
Feel better in my body & look better in clothes
8
How old are you?* This field is required.
9
Gender assigned at birth* This field is required.
Male
Female
10
What best describes your current situation?
None of these apply to me
Pregnant
Trying to conceive soon
Breastfeeding
11
Metabolic and Hormonal Conditions* This field is required.Do you have any of the following conditions? (Select all that apply)
None of these apply to me
Type 1 Diabetes
Type 2 Diabetes
Diabetic ketoacidosis (DKA)
Hypoglycemia (low blood sugar)
Thyroid issues (Hypothyroidism / Hyperthyroidism)
Personal or family history of medullary thyroid carcinoma (MTC)
Multiple Endocrine Neoplasia Syndrome Type 2 (MEN 2)
Polycystic Ovary Syndrome (PCOS)
Metabolic syndrome
12
Digestive and Organ Health* This field is required.Do you have any of the following conditions? (Select all that apply)
None of these apply to me
Pancreatitis or pancreatic issues
Severe gastrointestinal conditions (including gastroparesis)
Liver disease (e.g., NAFLD, cirrhosis)
Kidney disease (Stage 3 or above)
End-stage renal disease or on dialysis
Gallbladder disease or removed gallbladder
Gastroparesis or slow digestion
GERD or acid reflux related to weight
Current symptomatic gallstones
13
Cardiovascular, Respiratory, and Other Health Conditions* This field is required.Do you have any of the following conditions? (Select all that apply)
None of these apply to me
Heart disease or heart conditions
High cholesterol or triglycerides
High blood pressure (Hypertension)
Sleep apnea
Osteoarthritis or mobility issues related to weight
Eating disorders (Anorexia, Bulimia, Binge Eating)
Muscular Dystrophy
14
Do you take any weight loss pills, teas, injectables or herbal supplements?
YESNO
15
Are you taking oral contraceptive pills or hormone therapy?
YESNO
16
Are you currently taking any of these medications?* This field is required.(Select all that apply)
I don’t use any of these medications
Insulin
Glimepiride (Amaryl)
Glimepiride (Amaryl)
Glibenclamide / Glyburide
Sitagliptin
Saxagliptin
Linagliptin
17
Have you used any GLP-1 medications in the past 2 months?* This field is required.
No, I haven’t used any GLP-1 medications recently
Yes – Tirzepatide (e.g., Mounjaro®, Zepbound®)
Yes – Semaglutide (e.g., Ozempic®, Wegovy®)
18
What was the dose of your most recent injection?* This field is required.
19
Do you have any other medical conditions, a history of surgeries, or anything else we should be aware of?
Huge
Large
Normal
Small
Ok
Ok
20
Name* This field is required.We use your full name to make sure your order is processed correctly and shipped without delays.
First Name
Last Name
21
Phone NumberWe’ll only use this to send delivery updates or reach you if there’s an issue with your order — no spam, ever.
22
Where should we send your treatment?* This field is required.Your location helps us choose the best shipping method and packaging. All orders come with free shipping straight to your door.
House No. / Lot / Street Name:
Barangay
City
Province
Zip Code
Please Select
Please Select
Afghanistan
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Vatican City
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Isle of Man
US Virgin Islands
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Western Sahara
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Other
Country
23
Terms and Conditions* This field is required.
Should be Empty: