The Peptide Lounge Wellness Snapshot

New member assessment.

Complete the guided screens, clarify your health goals, and create a physician-ready wellness snapshot before your consultation.

This assessment is designed to support conversations around longevity, body composition, sleep, recovery, calm, hormones, vitality, lifestyle foundations, and readiness for a structured plan.

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Profile

Enter the details that personalize your member assessment and snapshot.

FIRST NAME *

LAST NAME *

EMAIL *

PHONE *

Date of Birth *

SEX *

PRIMARY FOCUS *

BEST TIME TO CONTACT *

WHAT ARE YOUR TOP 2-3 WELLNESS GOALS? *

ANYTHING YOU CARE TEAN SHOULD KNOW BEFORE YOUR CONSULTATION *

Peptide Goals

Tell us how strongly each area aligns with what you hope to improve through a clinician-guided program.

Increase energy, drive, and daily stamina *

Improve body composition or support weight loss *

Recover faster from workouts, travel, or stress *

Improve focus, mental clarity, or cognitive sharpness *

Sleep more deeply and wake more restored *

Support healthy aging and longevity goals *

Calm / Anxiety

A simple snapshot of tension, calm, and mental load over the last two weeks.

Feeling overly nervous, tense, or on edge *

Difficulty controlling worry or racing thoughts *

Trouble relaxing or settling your mind and body *

Restlessness or feeling unable to slow down *

Irritability or feeling easily triggered *

Concern that stress is affecting your performance or quality of life *

Sleep

Help us understand how restorative your sleep feels right now.

Difficulty falling asleep *

Waking up during the night or too early *

Snoring, shallow sleep, or breathing concerns *

If known or observed by a partner

Waking up unrefreshed or low energy *

Needing caffeine or stimulants to get going in the morning *

Sleep problems affecting mood, focus, or performance *

Stress

This section looks at how much pressure your mind and body may be carrying lately.

Feeling overwhelmed by responsibilities *

Feeling like you are constantly “on” and unable to reset *

Emotional strain affecting your health or relationships *

Physical stress signals such as tension, headaches, or muscle tightness *

Feeling behind, scattered, or unable to stay in control *

Stress interfering with your wellness habits or consistency *

meaningful slow steady

Hormones

This screen looks for symptoms that can suggest hormone shifts relevant to men’s health, women’s health, low testosterone, or perimenopause support.

Low libido or reduced sexual interest *

Reduced drive, motivation, or confidence *

Loss of lean muscle, strength, or slower recovery *

Increasing abdominal fat or changes in body composition *

Brain fog, poor focus, or low mental sharpness *

Sleep disruption, hot flashes, or night sweats *

Use this item if relevant to your symptoms

Changes in cycle regularity, mood, or temperature sensitivity *

Use if relevant for women/perimenopause

Changes in erections, morning erections, or sexual performance *

Use if relevant for men

Vitality

Think of this as your current energy, resilience, and performance baseline.

You feel mentally sharp and productive through the day *

You have enough physical energy for work, exercise, or family life *

Your mood and motivation feel steady *

You feel resilient after demanding days or travel *

Your workouts or physical activity feel rewarding rather than draining *

You feel younger than your chronological age *

Use this item if relevant to your symptoms

Lifestyle

A structured plan works best when the daily foundation is visible.

Your nutrition is generally aligned with your goals *

You exercise or move your body consistently *

You prioritize sleep and recovery routines *

You manage alcohol, nicotine, or other habits in a way that supports your goals *

You are consistent with supplements, medications, or self-care habits when recommended *

You have time, support, or systems to follow through on a structured plan *

Use this item if relevant to your symptoms

Readiness

Readiness helps us understand whether this is the right time to start and stay consistent with a guided program.

You are willing to complete recommended lab work or body composition testing *

You are open to making meaningful lifestyle changes alongside therapy *

You want a plan that is physician-guided rather than self-directed *

You are motivated enough to follow through over the next 8-12 weeks *

You feel ready to invest time and attention into your health goals *

You would value a clear, personalized roadmap for optimization *

Use this item if relevant to your symptoms

Total 0–79 → "Foundational Plan recommended"

Total 80–159 → "Optimization Plan recommended"

Total 160–245 → "Maintenance & Longevity Plan recommended"

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