1

Goal setting

Let's start with a bit about you and what you're hoping to achieve.

First name

Email address

Main goals (select all that apply)

What outcome are you hoping for? What does success look like in 4–12 weeks?

Have you tried anything similar before? What were the results?

2

Current health status

Be as thorough as you can — this is the foundation of a safe protocol.

Age

Height

Weight

Any diagnosed medical conditions?

Do any of the following apply to you? (select all)

Autoimmune condition Cardiovascular issues Liver or kidney problems History of cancer Hormonal disorders Pregnant or breastfeeding None of the above

Have you had blood tests in the last 12 months?

Yes — I have recent results No, but I can arrange them No

3

Medications & supplements

Include everything — even if you think it's minor.

Current medications (include dose if known)

Hormone therapies? (HRT, TRT, contraceptive pill, thyroid, etc.)

Supplements currently taking

Have you used peptides before?

Yes No

Any previous adverse reactions to medications or supplements?

4

Lifestyle factors

Lifestyle is a big piece of the protocol puzzle.

Sleep quality

Poor Great 5

Stress levels

Low High 5

Exercise frequency

None 1–2x / week 3–4x / week 5+ / week

Type of training

Alcohol intake

Smoking / vaping

Diet style

Daily water intake

5

Body composition & performance

Complete if relevant to your goals — rough estimates are fine.

Estimated body fat %

Rough estimate is fine

Weekly training volume

Recovery issues

Current injuries or pain points

Muscle-building goals — what are you working towards?

6

Skin, hair & cosmetic goals

Relevant for GHK-Cu, collagen-focused, and cosmetic peptide protocols.

Skin concerns (select all that apply)

Hair thinning or loss?

Yes No Starting to notice

Wound healing concerns or scarring?

Desired cosmetic outcomes

7

Previous peptide experience

If you're new to peptides, just skip the detail fields.

Have you used peptides before?

Yes No

8

Monitoring & compliance

Tracking progress is how we know what's working.

Will you commit to tracking your progress? (photos, measurements, journal)

Yes I'll try Unlikely

Comfortable completing baseline and follow-up bloodwork?

Yes — happy to I'd like to discuss this first Not at this stage

Do you understand that individual outcomes vary and are not guaranteed?

Yes, I understand I have questions

Are you prepared to pause or stop the protocol if you experience adverse effects?

Yes, absolutely I'd want to discuss first

9

Expectations check

Honest answers here help us set you up for a positive experience.

What timeline are you expecting to see results?

Are you looking for gradual improvement, or hoping for rapid change?

Gradual & sustainable As fast as possible Fast start, then maintain

Any other expectations, questions, or concerns to share?

10

Safety screening

Do any of the following apply to you? (select all that apply)

History of severe allergic reactions / anaphylaxis Active cancer diagnosis or currently in treatment Unexplained symptoms currently under investigation Recent surgery (within 3 months) Serious psychiatric condition Uncontrolled chronic disease None of the above

Anything else I should know before we begin?

Elevate Training

Questionnaire complete