Page 1 of 1

Custom Peptide Protocol by David

Section 1 - Legal & Consent

I understand that peptides are for research purposes only, not approved for human use, and that all information provided is for educational purposes only.

Untitled multiple choice field
A
B

Section 2 - Contact Information

Full Name

Email Address

Phone Number (not required)

Preferred Method of Contact

Preferred Method of Contact

Section 3 - Primary Goal(s) for Peptide Use

Check all that apply

Check all that apply

If Other, input below

Section 4 - Current Stats

Age

Sex

Sex
A
B
C

Height (inches or cm)

Weight (lbs or kg)

Body Fat % (if known)

Activity Level

Activity Level
A
B
C
D
E

Section 5 - Medical & Health Background

Do you have any diagnosed medical conditions (If yes, please list them)

Any history of:

Any history of:

Current Peptides, PEDs, Medications, and Supplements

History of peptide or hormone use (If yes, list compounds & dosages used before)

Do you have any allergies (If yes, please list allergies)

Section 6 - Lifestyle & Training

Training Frequency

Training Frequency
A
B
C
D

Main Types of Training

Main Types of Training

Diet Type

Diet Type
A
B
C
D
E
F
G
H

Alcohol Consumption

Alcohol Consumption
A
B
C

Tobacco or Recreation Drug Use

Tobacco or Recreation Drug Use
A
B

Stress Level

Stress Level
A
B
C

Average Sleep per Night

Average Sleep per Night
A
B
C
D

Section 7 - Specific Goals & Timeline

What's your #1 short-term goal

What's your #1 long-term goal?

Desired timeline for results

Desired timeline for results
A
B
C

Are you open to stacking multiple peptides if it's more effective?

Are you open to stacking multiple peptides if it's more effective?
A
B

Section 8 - Budget & Commitment

Monthly budget for peptide protocols

Monthly budget for peptide protocols
A
B
C
D

Willing to commit to lifestyle changes alongside peptides?

Willing to commit to lifestyle changes alongside peptides?
A
B

Section 9 - Additional Notes

Is there anything else you want me to know before we create a custom research protocol?

Attached Bloodwork or any other necessary documents (not required)

Medical Disclaimer & Client Acknowledgment

By signing below, I understand that any information, guidance, or protocol discussed by David / DPRO Health is for educational and informational purposes only and is not medical advice, diagnosis, treatment, or a prescription.

I understand that David / DPRO Health is not acting as my physician or licensed healthcare provider. I am responsible for consulting with a qualified medical professional before starting, stopping, or changing any peptide, supplement, medication, injection, diet, training plan, or health-related protocol.

I understand that peptides, supplements, and related compounds may carry risks, side effects, and unknown outcomes. Any decision I make to use or follow any information provided is voluntary and done at my own risk.

By signing, I accept full responsibility for my health decisions and agree to hold harmless David / DPRO Health from any claims, damages, adverse effects, injuries, or consequences related to my use or misuse of the information provided.

I confirm that the information I provided on this intake form is accurate and complete to the best of my knowledge.

Signature

One Time Custom Peptide Protocol

You will receive your peptide protocol through email within 24-72 business hours of purchase. You will be contacted by your preferred method once the peptide protocol has been emailed to you.

Loading...
(Credit cards are processed through Stripe)