1. What does a typical workweek look like for you hours, stress level, and responsibility? *

2. Do you feel like your energy matches the level your career demands right now? *

Yes

3. Are you currently in a salaried role, self-employed, or a combination of both? *

Salaried role

Self-employed

Combination of both

4. Over the last 6–12 months, what changes have you noticed in energy, drive, or recovery? *

5. How’s your focus and mental sharpness compared to a few years ago? *

6. Do you feel like your workouts give you the return they used to? *

7. How’s your sleep quality do you wake up rested or already tired? *

8. Has your confidence or motivation taken a hit at all, even if everything looks ‘fine’ on paper? *

9. Do you feel as driven outside of work training, intimacy, competition as you used to? *

10. If nothing changed hormonally over the next 3–5 years, how would that impact your lifestyle? *

11. Have you ever had your testosterone, SHBG, or estradiol tested? *

12. Are you currently on any medications or protocols for performance, longevity, or recovery? *

13. Do you see health optimization as a necessary investment or something you prefer to put off? *

14. If labs showed you were clinically low, would you be open to a long-term, physician-guided protocol? *

15. Are you looking for a basic prescription, or a concierge-level program that optimizes performance, labs, and longevity? *

16. Have you noticed a drop off in libido? *

17. Have you noticed a decrease in your sexual function from your prime? *

18. Is your current physician adequately addressing your concerns about lab work, supplements, and hormones? *

19. Do you feel like you have good guidance regarding decisions you are making with your health? *

20. How was your previous experience with telemedicine for health optimization? *

21. What did you previous telehealth provider do well that you enjoyed? *

22. Where did your previous telehealth provider come up short? *

23. Where have you previously received telemedicine services for lab work, peptides or hormones? *

Full Name *

Email *

Phone *

Date of birth

Gender *

Male

Female

Address *