Metabolic Health Assessment
Let’s get started! These quick questions help me learn about your goals and determine if this reset is the right fit for you.
Tell me about yourself
First and Last Name
*
Best Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Where did you hear about me?
Please Select
Instagram
Facebook
TikTok
Friend
If you selected ‘friend’ - Please specify their name.
Your Vision + Your Why
Describe your perfect day in your healthiest, strongest, most confident body. Describe it to me like a movie
*
What part of that picture are you missing most right now?
*
What would change first for you or your family if you got that part back?
*
Your Current Metabolic Symptoms
Which of these describe you right now?
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Fatigue or low energy
Difficulty losing weight
Poor digestion or bloating
Mood swings or irritability
Sleep problems
Sugar cravings
Brain fog or difficulty concentrating
Slow metabolism
Hormonal imbalances
Frequent hunger or overeating
Other
On a scale 1-10, how out of sync does your metabolism feel?
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Thriving
1
2
3
4
5
6
7
8
9
SOS
10
1 is Thriving, 10 is SOS
What have you tried so far to fix this?
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Diet changes
Exercise routines
Supplements or vitamins
Detox programs
Medication
Therapies or coaching
Fad diets
None
Other
Why do you think those things did not work long term?
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How is this struggle affecting your life right now?
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Reduced energy and motivation
Impact on family relationships
Work productivity decline
Mental health challenges
Physical discomfort or pain
Social withdrawal
Financial stress
Other
If nothing changes in next 6-12 months, what do you think happens?
*
What results are you hoping for
What matters most to you right now?
*
Improved energy and vitality
Weight loss and body composition
Mental clarity and focus
Better sleep quality
Emotional balance
Long-term health and longevity
Other
What support do you feel you need most to follow through?
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Accountability coaching
Personalized meal plans
Exercise guidance
Mindset and motivation support
Stress management techniques
Community support
Other
What current habits or patterns hold you back most?
*
Are You Ready for a True Metabolic Reset?
If there was a proven path that burns fat, protects 98% of your lean mass, and reverses metabolic dysfunction, how open are you to following it exactly as designed?
Very open and committed
Somewhat open, need more info
Not sure yet
Not open at all
Are you prepared to invest time, energy, and money into your health if the plan fits you?
Yes
Yes but need details
Not right now
If accepted, how soon would you want to start?
Right away
This week
Within the next two weeks
Metabolic Reset Results
Anything else you want me to know before I review your application?
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*
Yes
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