First Name

Last Name

Phone *

Email *

I consent to receive SMS application follow-up messages and reminders from The Lipo Lounge & Spa about the Founding Cohort. I agree to the terms and conditions and privacy policy. Message frequency may vary. Message and data rates may apply. Reply "Help" for assistance. You can reply "STOP" to opt out at any time.

I consent to receive SMS marketing communications from The Lipo Lounge & Spa about the Founding Cohort, including special offers, discounts and new product updates. I agree to the terms and conditions and privacy policy. Message frequency may vary. Message and data rates may apply. Reply "Help" for assistance. You can reply "STOP" to opt out at any time.

Age band

Are you in menopause or perimenopause?

Yes

Not sure

N/A

GLP-1 history

Currently on one

Used one in the past

Never

Prefer to discuss

Your biggest struggle right now

Meals cooked at home per week

0–2

3–5

What does success look like for you in 6–9 weeks?

Are you pregnant, nursing, or planning pregnancy in the next 3 months?

Yes

Do you have a history of eating disorders?

Yes

Prefer to discuss

Current medications

Any major medical conditions we should know about?

Which program are you drawn to?

THINNR (6 weeks)

New Wave (9 weeks)

Not sure — recommend for me

Cohort agreement *

I agree to baseline, Week 3, Week 6 and end-of-program measurements (incl. STYKU scan for local participants) a brief weekly check-in, and a short end-of-program survey.

I understand enrollment is final and no refunds are offered; I receive the full program information upfront, along with the drops and coaching access, and I will check with my own doctor before enrolling if I have any concern about completing the program.

Sharing permission

Full story (name + photos)

First name + photos

Anonymous (group totals only)

Decide later with the team

Release acknowledgment *

I understand a separate signed testimonial release is required before my name or photos are used.