Peptide Education Framework™
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Referred By
Network Trainer ID
trainerEmail
What is your main goal right now?
Lose stubborn fat
Improve recovery
Build/maintain muscle
Increase energy
Balance hormones
Your age:
40–49
50–59
60+
Under 40
Gender:
Male
Female
What frustrates you most right now?
I can’t lose fat no matter what
I’m always sore or tired
My energy is low
My body feels “off” (hormones, mood, weight)
How often do you train?
Rarely
2–3x/week
4–5x/week
6+ times/week
How would you describe your recovery?
Slow
Average
Good
Sleep quality:
Poor
Okay
Great
Energy levels:
Crash during the day
Up and down
Stable
What is your biggest body concern?
Stubborn fat
Losing muscle
Both
Neither
Libido:
Low
Moderate
Strong
Nutrition:
Poor
Decent
Dialed in
Have you used peptides before?
No
A little
Yes
“This assessment is for educational purposes only and does not provide medical advice.”
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