PeptideReport.ai — Free Report Intake

1Basic Body Metrics

Your account profile fills these permanent fields automatically.

Age *

Sex *

Height (ft) *

Height (in) *

Weight (lbs) *

Goal weight

Body fat % (if known)

Waist (if known)

2Main Goals

Check all that apply. *

Not sure which to choose? A quick guide to what each area covers: Blood sugar / energy crashes — blood sugar, insulin resistance, prediabetes, A1C Fat loss / weight loss — fat loss, body recomposition, appetite and cravings Focus / brain fog / mood — concentration, mental clarity, mood, cognition Frequent illness / inflammation — immune resilience, frequent illness, inflammation concerns Joint pain / recovery — joint pain, tendons and ligaments, healing after injury Libido / sexual wellness — libido, vitality, and sexual-wellness concerns Longevity / healthy aging — healthy aging, cellular wellness, long-term vitality Low energy / fatigue — low energy, afternoon crashes, motivation, stamina Muscle gain / recomposition — building or preserving muscle, strength, workout output Skin / hair / aging — skin tone and texture, hair, collagen, aesthetics Sleep / recovery — sleep quality, falling or staying asleep, recovery, burnout Other / unsure — not sure, or not listed — the report will help orient you

3Top Symptoms or Concerns

Check all that apply. *

4Current Activity Level

Sedentary

Light activity

Moderate exercise

Very active

Competitive / advanced

5GLP-1 & Product Familiarity

Have you used peptides or GLP-1 medications before?

No

Yes — peptides

Yes — GLP-1

Yes — both

Not sure

If your report includes a GLP-1 option, which would you prefer to learn about?

Retatrutide

Semaglutide

Tirzepatide

Let the report suggest

Not interested in GLP-1

6Monthly Budget Comfort Range

Under $250

$250–$500

$500–$1,000

$1,000+

Not sure yet

7Primary Focus for Your Free Report

In one sentence, what do you most want help understanding? *

8Current Lifestyle Snapshot

Sleep hrs/night *

Exercise days/week *

Caffeine/day

Alcohol/week

Nutrition style / restrictions

9Health & Safety Screening

Check any that apply. If several apply, the Comprehensive Intake gives a fuller review.

If any apply, briefly explain (no personal-identifying info):

10Current Medications, Supplements & Allergies

Check any food allergies, then list current medications & supplements below.

Search and select current medications (generic names). Add supplements or anything missing under Other, or leave blank / N/A if none:

11Anything Else We Should Know?

Relevant history, goals, preferences. Do not include personal-identifying information. If none, write N/A.

12Required Acknowledgment

Please review and check all before generating your report. *

All boxes below are required. Your report cannot be generated unless every acknowledgment is checked.

I understand this intake and any resulting report are AI-assisted educational materials only — not medical advice, diagnosis, treatment, prescribing, dosing, or a recommendation, and not reviewed or approved by any human medical provider. I understand no physician–patient, provider–patient, pharmacist–patient, coaching, or other professional relationship is created. I will review this report — and any health, medication, supplement, peptide, product, diet, or exercise decision — with my own licensed clinician before acting on it. I understand the compounds discussed are not FDA-approved to prevent, treat, or cure any condition, and any doses or schedules shown are a general educational reference I must confirm with a licensed clinician before use. I understand AI-generated content may be incomplete, inaccurate, or outdated, and use of this report is at my own risk. I will not enter personal-identifying information in free-text fields unless the secure platform specifically requests it. I confirm I am at least 21 years old.

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