To Get My Peptide Guide
Complete this 1 minute quiz and I will email you a copy!
Section 1: Basic Information: Full Name
First Name
Last Name
E-mail Address
example@example.com
Contact Number
Format: (000) 000-0000.
Age
Height
Current Weight
Who may I thank for referring you to me?
First Name
Last Name
Section 2: What Are Your Main Goals? (Check all that apply)
Fat loss
Reduce belly fat / visceral fat
Increase energy
Better sleep
Improve muscle tone / preserve muscle
Recovery from workouts
Reduce inflammation
Hormone balance
Healthy aging / longevity
Brain focus / mental clarity
Blood sugar support
Immune support
Libido support
Skin / hair / collagen support
Injury recovery
Other
Section 3: Medical History: Have you ever been diagnosed with any of the following? (Check all that apply)
Thyroid condition
High blood pressure
Diabetes / insulin resistance
Autoimmune condition
Heart disease
Kidney disease
Liver disease
Hormone imbalance
PCOS
Menopause / perimenopause
Anxiety / depression
None of the above
Other
If other, please specify.
Section 4: Cancer & Serious Medical History: Have you ever had cancer? If yes: Type of cancer. Year diagnosed, Are you currently under treatment?
Section 5: Current Medications / Supplements: Please list current medications, hormones, peptides, or supplements you are taking:
Section 6: Injuries / Physical Concerns: Do you currently have any injuries, chronic pain, or healing concerns?
Joint pain
Muscle injury
Back pain
Shoulder pain
Knee pain
Recent surgery
No current injuries
Other
Section 7: Peptide Experience: Have you used peptides before?
Please Select
Yes
No
If yes: Which peptides have you used?
Section 8: Lifestyle Questions: How many days per week do you exercise?
0-1
2-3
4-5
6+
How would you describe your eating style?
Very healthy / structured
Mostly healthy
Inconsistent
Need help
Sleep quality:
Great
Fair
Poor
Stress level:
Low
Moderate
High
Section 9: What Are You Most Hoping Peptides Will Help With?
Section 10: Preferred Next Step
I want guidance and would like to speak with Alexis Caputo
I already know what I want and prefer ordering directly
I need more education first
I want Shelly to help guide me
Section 11: Safety Statement: I understand peptides are wellness tools and not all peptides are appropriate for every individual. Medical consultation may be recommended depending on health history. Peptide Wellness Disclaimer & ReleaseBy submitting this form, I understand that information provided through Warrior Soul Wellness is for educational and wellness guidance purposes only and is not intended to diagnose, treat, prescribe, or replace medical advice from a licensed healthcare provider.I understand that peptide recommendations, education, and wellness discussions provided by Shelly/Warrior Soul Wellness are based on general wellness goals and are not medical prescriptions or guarantees of outcome.I acknowledge that any decision to begin peptide therapy, supplements, hormone support, or related wellness protocols should be discussed with a qualified medical provider, especially if I have a history of cancer, thyroid disease, cardiovascular disease, autoimmune conditions, hormone-sensitive conditions, or other medical concerns.I understand that licensed medical providers, including Nurse Practitioner Alexis Caputo, may recommend lab work, further evaluation, or medical supervision before peptide use.I voluntarily assume full responsibility for my health decisions and release Warrior Soul Wellness, Shelly, affiliated educators, and wellness partners from liability for outcomes related to products purchased, protocols selected, or health decisions made outside of direct licensed medical supervision.☐ I have read and agree to this statement
I have read and agree to this statement
Let’s Find What Fits Your Body Best
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