Client Consultation → Newbridge Peptides

Please answer the questions below as accurately as possible. This information will help me better understand your goals, current lifestyle, health background, and what you hope to accomplish so we can have a more productive consultation.

1. Basic Information

First Name *

Last Name *

Email *

Phone

Age *

Height

Current Weight

If weight loss or body recomposition is a goal, what is your goal weight?

Have you recently gained or lost a significant amount of weight? If so, approximately how much?

2. What Are Your Primary Goals?

If other, please specify

Of everything you selected, what is your #1 priority right now? *

Why is accomplishing this goal important to you?

On a scale of 1–10, how important is achieving this goal to you?

1 = not important, 10 = extremely important

3. Medical & Health Background

Do you currently take any prescription medications, over-the-counter medications, hormones, vitamins, or supplements? *

If yes, please list them.

Do you have any diagnosed or pre-existing medical conditions? *

If yes, please explain.

Do you have any current or previous injuries, chronic pain, surgeries, or physical limitations that may be relevant to your goals?

Do you have any known allergies or medication sensitivities?

Have you ever experienced problems with blood pressure, blood sugar, insulin resistance, cholesterol, thyroid function, kidney/liver function, or cardiovascular health? *

If yes, please explain.

4. Lab Work

Have you had a comprehensive blood test panel within the last 6–12 months? *

Yes
No
Not sure

If yes, are you comfortable sharing your recent lab results for review during your consultation?

5. Nutrition & Lifestyle

On a scale of 1–10, how would you rate your current nutrition?

1 = poor, 10 = excellent

Briefly describe what a typical day of eating looks like for you.

Approximately how many hours do you sleep per night?

How would you rate your average daily stress level from 1–10?

1 = very low, 10 = very high

6. Fitness & Activity

If other, please specify

How many days per week do you currently exercise?

Are you willing to follow a structured fitness routine and work on building better nutritional habits throughout this process? *

Yes
Possibly, with guidance
Not currently

7. Peptide / GLP-1 Experience

Have you ever used or researched peptides, GLP-1 medications, growth-hormone-related compounds, or other similar therapies before? *

If yes, which ones have you previously used or researched?

Did you experience any benefits, side effects, or problems that you feel are important for me to know about?

What initially sparked your interest in peptides?

8. Expectations & Commitment

What would a successful outcome look like to you over the next 3–6 months? *

Are you looking primarily for education and guidance, or are you also interested in ongoing coaching, accountability, nutrition, supplementation, and fitness support?

Education and guidance only
Ongoing coaching, accountability, nutrition, supplementation & fitness support
Not sure yet

How ready do you feel to make consistent lifestyle changes to support your goals?

1 = not ready, 10 = fully ready

9. Questions for Me

What questions or concerns do you currently have regarding peptides, your goals, the research, potential risks, side effects, or the overall process?

Is there anything else about your health, lifestyle, previous experiences, or goals that you think would be important for me to know before our consultation?

This questionnaire is intended to collect background information for educational and research discussions. It is not a substitute for medical diagnosis, treatment, or individualized medical care from a licensed healthcare professional.

Primarily U.S. Manufactured. All Compounds Independently Tested in U.S. Laboratories.