Membership Intake Improvement Plan Your Personal Improvement Plan Please take the time to answer these questions truthfully and honestly. This will help us get better insight on what you're currently struggling the most with & how we can help you best. WHAT’S YOUR BIGGEST HEALTH GOAL RIGHT NOW? * Losing stubborn weight / body transformation Improving my sleep and feeling rested Boosting my daily energy and performance Reducing stress, brain fog, or trouble focusing Slowing aging and staying healthy long-term General wellness / not sure, just want to feel better WHICH OF THESE CHALLENGES DO YOU FACE MOST OFTEN? * I have trouble losing weight even with diet and exercise I wake up tired or struggle to fall/stay asleep I feel low energy or burned out during the day I have brain fog, stress, or anxiety that gets in the way I’m worried about aging, recovery, or long-term health WHAT HAVE YOU TRIED IN THE PAST? * Diets or supplements Fitness or body treatments IV therapy or injections Prescription medications Nothing yet WHAT MATTERS MOST TO YOU IN A PROGRAM? * Fast results Long-term sustainability Non-invasive treatments Medical and scientific approach Support and accountability How would you describe your daily energy? * Low Moderate High Do you exercise regularly? * Yes No Full Name * Email * Health Card Number (For Blood work requisition) * Health Card Version Code ( 2 Letters) * Date of Birth * Submit
