Fit Life LDN — Peptide Pre-Assessment

01

Personal Details

Full Name

Date of Birth

Email Address

Phone Number

Location / Area

Occupation

02

Goals & Motivation

Primary Goal — tick all that apply

Target Weight / Body Fat %

Timeframe / Deadline

What motivated you to explore peptides?

03

Health & Medical History

Do you have any existing medical conditions?

Yes No

If yes — please describe

Currently taking any medications or supplements?

Yes No

If yes — please list

Any known allergies?

Yes No

If yes — please describe

Blood work in the last 6 months?

Yes — results available Yes — not available No

04

Training & Lifestyle

Current training frequency

Not training 1–2x / week 3–4x / week 5+ / week

Training experience level

Beginner Intermediate Advanced Competitive

Current diet approach Average sleep per night

Under 5 hrs 5–6 hrs 6–7 hrs 7–8+ hrs

Stress levels (average)

Low Moderate High Very High

Alcohol consumption

None Occasional Weekly Regular

05

Peptide & Compound History

Have you used peptides before?

Yes No

If yes — which ones and what was your experience?

Comfortable with self-injection (SubQ)?

Yes No — need guidance Not sure yet

06

Current Measurements

Height

Current Weight

Waist (approx.)

Body Fat % (if known)

07

Declaration

I confirm that the information provided above is accurate to the best of my knowledge. I understand that peptide protocols are provided for research and educational purposes and that Fit Life LDN is not a medical practice. I take full personal responsibility for my own health decisions made as a result of this consultation.

Full Name (signature)

Today's Date

Assessment Received