Peptide Quiz
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" indicates required fields
Step
1
of
10
10%
What is your current age range?
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Under 30
30-39
40-49
50-59
60+
Are you currently taking any hormone-related therapies or supplements?
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Select all that apply.
Bioidentical hormone therapy (e.g. estrogen, progesterone, testosterone)
Thyroid medication
Over-the-counter supplements for energy, sleep, or metabolism
None of the above
How would you describe your primary health goals?
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Select all that apply.
Sustainable weight loss
Enhanced athletic performance
Accelerated healing or injury recovery
Hormone balance and mood support
Cognitive clarity and focus
Anti-aging and skin rejuvenation
Immune or gut health support
Energy and sleep optimization
Which of the following best describe your current health concerns?
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Select all that apply.
Fatigue or brain fog
Difficulty losing weight
Chronic pain or inflammation
Poor sleep or low recovery
Low libido or hormone imbalance
Slow muscle recovery or performance plateaus
Mood swings or anxiety
None of the above
Which best describes your lifestyle?
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Sedentary, minimal exercise
Light/moderate movement (1–2x/week)
Active (3–5x/week of workouts)
High-performance (athlete or regular training)
Have you ever used peptide therapy before?
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Yes, currently using
Yes, previously used
No, but I’ve heard of it
No, this is new to me
How soon are you looking to get started?
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ASAP
Within the next 30 days
I’m just learning for now
Would you be interested in a virtual consultation to learn more?
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Yes
Maybe
No
How would you like to be contacted?
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Call
Text
Email
All
Let’s keep in touch!
First Name
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Last Name
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Phone
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Email
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Outreach Acknowledgement
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By clicking “Submit”, I acknowledge that Beauty Culture Spa will use the information above to contact me through phone, email, and/or text.
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