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Prexalite 12™ Application

Prexalite™ provides individualized virtual weight-loss and performance coaching for busy professionals seeking a structured, sustainable approach to improving body composition, fitness, and lifestyle habits.

Complete this application to determine whether the Prexalite™ 12-week transformation system is appropriate for your goals.

Full Name

Email Address

Biological sex (used for fueling, training context)

Height

Weight

Primary Training Focus (select one)

A
B
C
D

What would you like to accomplish within the next 12 weeks, and why is this important to you now?

Is there anything that would prevent you from following a structured plan?

A
B
C
D
E

Occupation

Typical work schedule, average work hours/week, and travel frequency

Realistic training commitment - Days per week and minutes per session.

Current exercise frequency, biggest obstacle to consistency

Equipment access - Full gym - Home gym - Dumbbells/bands - Bodyweight only - Other

Training limitations - Previous injuries still affecting activity, movement restrictions, clinician instructions.

Typical weekday of eating - Meals, snacks, drinks, timing; walk me through yesterday.

Food preferences and constraints - Plant-based/vegetarian pattern, cultural preferences, allergies, intolerances, foods avoided.

Hydration and alcohol - Typical fluid intake; alcohol frequency if applicable.

Sleep - Typical hours, consistency, quality 1–10.

Are you prepared to invest into a 12-week individualized transformation program if Prexalite™ determines that you are a good fit?

A
B

Agreement

No medical, physical therapy, or clinical services are provided.

Information shared is not intended to diagnose, treat, or replace medical care.

Clients are responsible for consulting licensed professionals regarding injuries, medical conditions, or health concerns prior to implementation.