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Last Name
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What is your top health goal right now?
Lose weight or control appetite
Recover from injury or build muscle
Look younger and glow
Improve sleep or daily energy
Balance hormones or boost libido
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How would you describe your energy levels?
I’m tired or burned out often
Fairly good, but could be better
Steady and strong most days
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Which statement best describes your current physical state?
Stubborn fat / struggle to lose weight
Recovering from injury or train hard
Skin changes or hair thinning
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How is your sleep?
I sleep poorly / wake often
Sleep is okay, but not refreshing
I sleep deeply and feel rested
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Are you experiencing any of the following?
Low libido / mood changes
Digestive discomfort / gut issues
No major concerns
How would you rate your recovery after physical activity?
Stay sore for days
Recover slowly but steadily
Bounce back quickly
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Which best describes your body composition goals?
Lose weight or reduce belly fat
Build or maintain lean muscle
Maintain but improve tone
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Do you feel hormonally balanced?
Not at all (mood swings, fatigue, libido issues)
Somewhat balanced
Yes
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How’s your digestion and gut health?
Bloating, discomfort, food sensitivity
Mild symptoms
No concerns
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Which of these outcomes would excite you most?
Shedding stubborn fat and feeling energized
Waking up refreshed and mentally clear
Glowing skin, thicker hair, improved tone
Feeling confident in your body/relationships
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