Coaching Call Intake

Before you begin — please read

This is a coaching call, not a medical appointment. Your Loop Lifestyle Coach is an educator, not a licensed medical provider. This call and any follow-up materials are for educational and informational purposes only. Nothing your coach shares — verbally, in writing, or in your recap — is medical advice, a medical diagnosis, or a prescription. Your coach cannot diagnose, treat, cure, or prevent any disease or medical condition.

Peptides, compounds, and GLP-1s discussed on this call are not FDA-approved for the diagnosis, treatment, or cure of disease. Prescription products available through Loop RX are prescribed by a licensed clinician — not your coach — who makes all prescribing decisions.

Always consult your licensed healthcare provider before starting any new supplement, peptide, GLP-1, or wellness protocol, especially if you are pregnant, breastfeeding, planning to conceive, taking prescription medications, or have any existing medical condition.

Nothing on this form or in our conversation replaces the care of your own physician. If you are experiencing a medical emergency, call 911 or your local emergency number.

Your intake responses are used to inform our coaching conversation. They are not shared with any third party outside of Loop's coaching and operations team. Loop does not sell or share your personal information. You can withdraw consent or request deletion of your intake at any time by emailing support@loop.health.

I understand that my Loop Lifestyle Coach is not a licensed medical provider, that this call is for educational and informational purposes only, and that nothing shared on the call constitutes medical advice, diagnosis, prescription, or treatment. I have read and agree to the disclaimer above.I confirm I am 18 years of age or older.

Contact basics

Full name*

Email*

Phone number

How did you find Loop?

A friend, a podcast, the website, social — anything you remember.

Goals

What are your top 2–3 goals?*

Examples: fat loss, improved energy, better sleep, muscle recovery, skin support, longevity, hormone balance. Pick the few that matter most.

What does success look like in 6 months?

How you want to feel, look, move, or perform. As specific as you want.

What are your current body composition goals?*

GLP-1 experience

Are you currently on or considering a GLP-1?*

Examples: Ozempic, Wegovy, Mounjaro, Zepbound, semaglutide, tirzepatide, retatrutide.

Peptide experience

Have you used peptides before?*

Things like BPC-157, GHK-Cu, NAD+, sermorelin, CJC/Ipamorelin, TB-500 — anything in that family.

Lifestyle context

This is the part the coach will build your protocol around. The more honest you are, the more useful the call is.

What does your diet typically look like?*

A rough picture — what you usually eat, how often, what you struggle with. Include alcohol if relevant.

What does your movement / training routine look like?*

Frequency, type, intensity. Mostly walking or none right now are both valid answers.

How is your sleep — quality and typical hours?*

Hours per night, how rested you feel, anything getting in the way (kids, pets, work, stress, devices).

What does your stress look like right now?*

Anything else about your day-to-day worth flagging?

Travel schedule, kids, shift work, caregiving, anything that affects the realism of a protocol.

Supplements

Are you currently taking any supplements you'd like to share?

Just supplements you want us to know about. (Not medications — we'll cover those on the call.)

Bloodwork

Have you had bloodwork done in the last 6 months?

Anything else?

Is there anything else you'd like your coach to know before your call?

Anything that didn't fit above. Concerns, questions, context, things you've tried that didn't work — whatever you want them to walk in knowing.

Let's get to know you first.