Zarak + Peak Human Intake

Thank you for your interest in becoming a Peak Human member. This intake form is designed to help us better understand your needs, goals, and current lifestyle so that our team can properly guide you.

Full Name *

Email *

Phone *

Our memberships range from approximately $1,800 to $25,000 per year, depending on the level of access and services. *

Health Card Number *

Version Code ( 2 Letters) *

What are your top 3 goals right now?

Improve energy and focus

Lose weight / tone up

Enhance recovery and performance

Slow aging and boost longevity

Optimize sleep and stress

Any particular health concerns you want to address? *

By submitting this form and signing up for texts, you consent to receive marketing text messages (e.g. promos, cart reminders) from [Your Company Name] at the number provided. Consent is not a condition of purchase. Msg & data rates may apply. Msg frequency varies. Unsubscribe at any time by replying STOP.