Start the Recovery Program – First Person Peptides

01 / About you

Full name *

Email *

Phone *

Date of birth *

Street address *

City *

State *

ZIP *

Delivery preference *

Ship to meHand off (local to Coach C)

02 / What you’re treating

What are you treating?

How long have you had this issue?

Have you had any treatments or surgeries for this issue?

03 / Health screening

Answer honestly. A “yes” doesn’t automatically disqualify you, but Coach C reviews flagged intakes before activating your program.

Are you pregnant, planning pregnancy, or breastfeeding?

NoYes

Do you have any known peptide allergies?

NoYes

Are you being treated for active cancer?

NoYes

Has a physician advised against peptide use?

NoYes

Are you currently taking any prescription medications?

Any chronic medical conditions Coach C should know about?

Start the recovery program.