Thank you for your interest in a GLP 1 Peptide Program!
This 10-week program is designed for women who are ready to microdose GLP-1s intentionally—with support, strategy, and lab testing to protect muscle, stabilize hormones, optimize metabolism and reduce unwanted side effects. If you’re tired of doing this alone, unsure how to use these medications safely, or want to avoid the rebound weight gain, this program is for you.Please complete the questions below so we can make sure it’s the right fit. Spots are limited, and this application helps us ensure you’ll get the support you need.
Name
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First Name
Last Name
Email
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example@example.com
Age?
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What state do you live in?
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What are you top 3 health goals right now?
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What interests you most about GLP-1 medications?
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Weight loss
Improved insulin resistance
Reduced inflammation
Appetite/craving control
Hormonal balance
Longevity/metabolic health
Other
If other, type it here
Have you tried a GLP-1 medication before?
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Yes
No
If "yes", which one and at what dose? Share your experience in detail below.
Current Weight
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Current Height
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Do you have any current diagnoses or medical conditions we should know about? Ex: diabetes, hypothyroidism, PCOS, autoimmune disease, etc.
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Are you currently taking any medications, including thyroid meds, birth control, antidepressants, or insulin?
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Yes
No
If "yes", please list:
Do you have a history of any of the following?
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Thyroid cancer
Pancreatitis
Gallbladder removal
Severe GI issues
Eating disorder
None of the above
Have you had recent lab work (bloodwork)?
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Yes
No
If yes, when and what type?
On a scale of 1-10, how ready are you to commit to a 10-12 week health program that includes coaching, labs, and lifestyle changes?
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Please Select
1
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10
Are you currently working with a healthcare provider or coach on your health goals?
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Yes
No
If "yes", please describe briefly:
This program includes functional testing (a hair mineral analysis), access to ordering your own bloodwork (if you'd like), a custom nutrition + mineral protocol, group coaching calls, 1:1 chat support, custom macros, and access to education modules. Are you able to invest in a program that will be priced around $697? NOTE: On average for micro-dosing a GLP peptide medication, you will spend around $120-$180 per month on medication.
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Yes
No
I'd like to learn more before deciding
Anything else you'd like to share about your health journey or goals?
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