Precision Protocols
🔒

Your privacy is protected. This intake form is strictly confidential and reviewed only by your coach to determine appropriate lab panels for your protocol. Your responses are never shared with third parties. For any question you are not comfortable answering, select "Prefer not to answer" — this will not affect your ability to participate in the program.

Female Client Intake

Let's build your protocol.

Here's how this works. We send you out for bloodwork to start. You tell us a little about yourself and your goals so we know exactly which labs to run. At the end of this form you'll book a 30 minute call with me. We'll email you a link too in case you need to book it later. No charges until you decide to move forward.

1
Personal
2
Goals
3
Health
4
Symptoms
5
Training

Complete this form before your call. Your responses help us determine exactly which lab panels to order.

Section 01 of 05
Personal Information
Fields marked with * are required.
Required
Required
Required
Required
Required
Billing Address
Required
Required
Required
Shipping Address
Section 02 of 05
Your Goals
Select your primary outcome and any add-on areas of interest. You can select multiple.
Primary Protocol Goal
Select everything that resonates. You can choose more than one.
90 Day Metabolic Melt
You've been battling against your own body. We run your labs and design a protocol built around your biology to support body fat reduction.
90 Day Metabolic Recomp
You've been putting in the work, but your body's not showing it. Your bloodwork will tell us exactly why. Your protocol will optimize your body composition and finally make the effort show.
The Full Restoration
Low energy, stubborn belly fat, and a drive that's quietly disappeared. These aren't signs of aging, they're hormonal, and your protocol will restore what you thought was just part of getting older.
The Performance Protocol
Your output is dropping, your recovery is slower, and your body is starting to push back. Your bloodwork tells us exactly what's limiting you and your protocol puts you back on top.
The Longevity Protocol
Nothing is wrong yet. That's exactly the right time to start. Your bloodwork tells us what's quietly declining before you feel it, and your protocol keeps you decades ahead of it.
Optional Add-on Stacks
These are optional additions to your primary protocol. Nothing here is required. Select anything that interests you and we'll discuss it on your call.
Recovery and Repair Stack
You've been training around things for so long that you just got used to it. It doesn't have to stay that way. A provider-guided protocol that supports what your body has been trying to fix on its own.
Sleep Stack
You can't fall or stay asleep, or you're in bed for eight hours and still waking up exhausted. A provider-guided protocol that works with your biology to support restorative deep sleep.
Focus Stack
The sharpness you used to rely on isn't showing up the way it used to. A provider-guided protocol that cuts through the fog and brings your mental edge back.
Bedroom Stack
Not a band aid. A provider-guided protocol that addresses desire and drive at the source, for men and women.
Hair, Skin and Nails Stack
What shows on the outside is a direct reflection of what's happening on the inside. A provider-guided protocol that supports your skin, hair, and nails at the cellular level.
Cellular Reboot Stack
Tired in a way that sleep doesn't fix. Foggy, inflamed, just off. A provider-guided protocol that supports your body's natural reset from the inside out.
What Have You Already Tried
Dieting / Calorie Counting
Exercise Programs
Supplements
Prescription Medications
Peptides
Therapy / Mindset Work
Section 03 of 05
Health History
All medical information is strictly confidential and used only to determine safe and appropriate lab panels for your protocol.
Current Medications
Check all that apply.
Metformin
Acid Reflux Medication
Antidepressant (SSRI/SNRI)
Pain Medication / Opioids
Thyroid — T4 only (Synthroid, Levothyroxine)
Thyroid — T3/T4 combo (Armour, NP Thyroid)
GLP-1 (Ozempic, Wegovy, Mounjaro)
Birth Control (pill, IUD, implant, patch)
Hormone Replacement Therapy
None
Current Supplements
Vitamin D
B12
Iron
Magnesium
Fish Oil / Omega-3
None
Medical History
Family history of heart attack or stroke, especially a parent or sibling under 60?
Yes
No
Prefer not to answer
Have you ever had your Lp(a) tested?
Yes
No
Not sure
Ever been diagnosed with Hashimoto's or autoimmune thyroid disease?
Yes
No
Prefer not to answer
Are you currently pregnant, breastfeeding, or trying to conceive?
Yes
No
Prefer not to answer
Section 04 of 05
Symptom Assessment
This section determines which additional lab panels to include with your core bloodwork. Answer as honestly as you can. Use "Prefer not to answer" at any time.
Energy, Sleep & Mood
Exhausted no matter how much you sleep?
Yes
Sometimes
No
Waking up between 2 and 4am and unable to get back to sleep?
Yes
Sometimes
No
Always cold, even when others around you are comfortable?
Yes
Sometimes
No
Brain fog, trouble concentrating, or mentally slow?
Yes
Sometimes
No
Mood swings, irritability, or depression that feels different from before?
Yes
Sometimes
No
Anxiety that came out of nowhere in the last few years?
Yes
Somewhat
No
Getting sick more often than you used to?
Yes
Somewhat
No
Numbness or tingling in hands or feet?
Yes
Sometimes
No
Hormone Symptoms
Hot flashes or night sweats?
Yes
Sometimes
No
Have your menstrual cycles changed noticeably in the last 1 to 2 years?
Yes
No
Prefer not to answer
Changes in feminine comfort or moisture levels?
Yes
Somewhat
No
Prefer not to answer
How would you describe your libido compared to a few years ago?
About the same
Noticeably reduced
Basically gone
Prefer not to answer
Been told your labs are normal but still feel awful?
Yes
No
Prefer not to answer
Did those labs specifically include Free T3, Reverse T3, and Progesterone?
Yes
No
Not sure
Been told your thyroid is fine but still have all the symptoms?
Yes
No
Prefer not to answer
Body Composition
Weight gain around the middle without a major change in diet or exercise?
Yes
Somewhat
No
Losing muscle or strength despite training consistently?
Yes
Somewhat
No
Flat, low drive, just going through the motions?
Yes
Somewhat
No
Body composition won't move no matter what you do?
Yes
Somewhat
No
Hair thinning or shedding more than normal?
Yes
Somewhat
No
History of heavier than normal menstrual flow?
Yes
No
Prefer not to answer
Restless legs, especially at night?
Yes
Sometimes
No
Chronic stress or burnout, feeling like your body is running on empty even at rest?
Yes
Somewhat
No
Low drive across the board, not just physically but motivationally and emotionally?
Yes
Somewhat
No
Weight won't move despite eating well and training consistently?
Yes
Somewhat
No
Section 05 of 05
Training & Lifestyle
This helps us build a training and nutrition plan that fits your actual life.
None
1-2x / week
3-4x / week
5x+ / week
Weights / Strength Training
Cardio / Running
Group Classes (Impact Fitness)
Hyrox / Functional Fitness
Yoga / Pilates
Sport / Recreational
None currently
How do you want to train during this protocol?
Semi-private training in person (Wayne) + check-ins on nutrition and fitness
Impact Group Membership + check-ins on nutrition and fitness
Strictly remote + check-ins on nutrition and fitness, custom training program included
Pretty solid, I eat consistently well
Emotionally driven or reactive
Always hungry or dealing with cravings
Restrictive or controlled
Unpredictable, varies day to day
Bloating
Irregular bowel movements
Cramping or pain
Acid reflux
None
Application received.

Book your call below.

Before your call there are no charges and no commitments. After your consultation, if you decide to move forward, a $250 onboarding fee covers your core LabCorp lab draw. Based on your intake responses, additional panels may be recommended at an additional cost.

If you have recent labs from the last 3 to 6 months, reply to your confirmation email with them attached and we'll discuss a discount on your call. All initial fees are credited toward your 90-day program.


(Booking link also sent to your email.)

Congrats on taking this step. A lot of people think about it. You actually did it. We'll see you on the call.