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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
I Agree & Understand
*
B
I Do Not Agree
Section 2 - Contact Information
Full Name
*
Email Address
*
Phone Number (not required)
Preferred Method of Contact
*
Preferred Method of Contact
Email
Text
Section 3 - Primary Goal(s) for Peptide Use
Check all that apply
*
Check all that apply
Fat Loss
Muscle Growth/Strength
Anti-Aging/Longevity
Injury Recovery/Healing
Energy & Focus
Hormone Optimization
Sleep Improvement
Skin & Hair Health
Immune Support
Gut Health
Other
If Other, input below
Section 4 - Current Stats
Age
*
Sex
*
Sex
A
Male
B
Female
C
Other / Prefer not to say
Height (inches or cm)
*
Weight (lbs or kg)
*
Body Fat % (if known)
Activity Level
*
Activity Level
A
Sedentary
B
Lightly Active (1-3 days/week)
C
Moderately Active (3-5 days/week)
D
Very Active (6-7 days/week)
E
Athlete / Competitive Training
Section 5 - Medical & Health Background
Do you have any diagnosed medical conditions (If yes, please list them)
*
Any history of:
*
Any history of:
Heart Disease
Diabetes / Insulin Resistance
Cancer
Hormone Disoders
Autoimmune Conditions
None of the above
Current Medications & 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
0 days/week
B
1-2 days/week
C
3-4 days/week
D
5-6 days/week
Main Types of Training
*
Main Types of Training
Weights / Resistance Training
Cardio
Sports / Martial Arts
Other
None
Diet Type
*
Diet Type
A
No specific diet/no calories tracking
B
Track macros/calories only
C
Low Carb
D
Keto
E
Intermittent Fasting
F
Carnivore
G
Mediterranean
H
Other
Alcohol Consumption
*
Alcohol Consumption
A
Never
B
Occasionally (1-2 drinks/week)
C
Frequently (3+ drinks/week)
Tobacco or Recreation Drug Use
Tobacco or Recreation Drug Use
A
Yes
B
No
Stress Level
*
Stress Level
A
Low
B
Moderate
C
High
Average Sleep per Night
*
Average Sleep per Night
A
Less than 5 hours
B
5-6 hours
C
7-8 hours
D
8+ hours
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
30 days
B
60 days
C
90+days
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
Yes
B
No
Section 8 - Budget & Commitment
Monthly budget for peptide protocols
*
Monthly budget for peptide protocols
A
Less than $150/month
B
$150-$300/month
C
$300-$500/month
D
$500+ per month
Willing to commit to lifestyle changes alongside peptides?
*
Willing to commit to lifestyle changes alongside peptides?
A
Yes
B
No
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)
Click to choose a file or drag here
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.
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