Full Name *

Email *

Phone *

Age Range *

Are you ready for a long-term strategic rebuild — not another reset? *

What are you here to change right now? (Choose all that apply) *

Weight resistance / stalled body composition

Stubborn belly weight / puffiness / inflammation

Gut issues (bloat, constipation, reflux, irregular digestion)

Hormone shifts (peri/menopause symptoms)

Sleep + fatigue / wired but tired

Energy crashes / cravings / blood sugar swings

Brain fog / mood shifts / anxiety

I want full-body optimization

What have you already tried that “should have worked,” but didn’t? (Short answer) *

What would a measurable win look like 6 months from now? (Short answer) *

Which of these are true for you right now? (Check all that apply) *

My body doesn’t respond like it used to

I train and eat clean but my body composition is stuck

Sleep doesn’t restore me

I feel puffy/inflamed (face, belly, joints)

Digestion is unpredictable

Cravings feel louder than my logic

I rely on caffeine to function

I feel wired but tired / under-recovered

Labs are “normal” but I don’t feel normal

How ready are you to start in the next 30 days if we’re a fit? *

This is a 6-month private mentorship and a premium investment. If we both agree it’s a fit, are you prepared to invest? *

Are you the decision maker for this investment? *