Please note: Solwomen provides peptide wellness consulting only. We are not your primary care provider and do not replace your existing medical team. It is your responsibility to maintain a relationship with a licensed physician who oversees your overall health.

1. Personal Information

First Name *

Last Name *

Date of birth *

Phone *

Email *

Weight (Ibs) *

Height *

Biological Sex *

Medications & supplements

Current prescription medications

Current supplements or over-the-counter products

Any known allergies (medications, foods, or substances)?

Hormone & reproductive health

What best describes your current hormonal status?

Are you currently pregnant, breastfeeding, or trying to conceive?

Yes

No

Not applicable

Prior peptide experience

Have you used peptides before?

No, this is new to me

Yes, some experience

Yes, extensively

If yes, please list any peptides you have used and your experience with them

How did you hear about Solwomen?

Is there anything else you'd like us to know before your consultation?

Acknowledgment & informed consent

1.Not a medical practice. Solwomen is a wellness consulting service. This consultation does not constitute medical advice, diagnosis, or treatment.

2.Physician oversight is my responsibility. I understand it is my responsibility to maintain a relationship with a licensed primary care physician or appropriate specialist who oversees my overall health and is aware of any peptides or protocols I choose to use.

3. Informational guidance only. Any peptide recommendations provided by Solwomen are for informational and educational purposes. Implementation of any protocol should be discussed with my personal physician.

4.Product liability. Solwomen is not responsible for any manufacturing issues, sterility, potency, or safety of any peptide. It is the client's responsibility to source peptides from reputable, third-party tested providers and to consult with their physician regarding product quality and suitability.

5.Accurate information. I affirm that the health information I have provided is accurate and complete to the best of my knowledge.

I have read, understood, and agree to the above statements.

Your responses are kept private and used solely to prepare for your consultation.

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1. Personal Information

2. Primary Health Goals

Current health status

We strongly encourage all clients to have an established PCP. We are happy to provide guidance on finding one if needed.

Medications & supplements

Hormone & reproductive health

Acknowledgment & informed consent

Your responses are kept private and used solely to prepare for your consultation.