GLP-1 Support Coaching Application

This short application helps me understand your current situation, goals, and whether this support may be the right fit for you. For this form, “GLP-1 medications” includes medications such as Ozempic, Wegovy, Mounjaro, Zepbound, semaglutide, and tirzepatide.

Most people complete this in about 3 minutes. If it looks like a good fit, you’ll be redirected to schedule a 20-minute clarity session where we can briefly discuss your situation and next steps. This clarity session is not a coaching session, medical consultation, or lab review.

Maria provides non-prescribing, lab-informed coaching and education. She does not prescribe medications or manage GLP-1 dosing. Medication decisions must always be made with your prescribing clinician.

GLP-1 Support Coaching Form

"*" indicates required fields

Step 1 of 3

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Name*

First Name Last Name

Email*

Age Range (optional)

25–34

35–44

45–54

55–64

65+

1. Which of the following best describes your current situation with GLP-1 medications?*

I am currently using a GLP-1 medication

I am currently using a GLP-1 medication and want a plan for eventually transitioning off

I am considering starting a GLP-1 medication

I previously used a GLP-1 medication and stopped

I cannot tolerate GLP-1 medications due to side effects

I am looking for weight loss support without using GLP-1 medications

2. Which medication are you currently using?*

Ozempic

Wegovy

Mounjaro

Zepbound

Compounded semaglutide

Compounded tirzepatide

Other

3. How long have you been using this medication?*

Less than 3 months

3–6 months

6–12 months

More than a year

4. What challenges or concerns are you currently experiencing?*

Select all that apply.

Weight loss plateau

Constipation

Nausea

Reflux or digestive discomfort

Low energy

Concern about muscle loss

Unsure how to eat while on GLP-1

Fear of regaining weight later

Other

2. Which medication are you currently using?*

Ozempic

Wegovy

Mounjaro

Zepbound

Compounded semaglutide

Compounded tirzepatide

Other

3. How long have you been using this medication?*

Less than 3 months

3–6 months

6–12 months

More than a year

4. What are your biggest concerns about eventually transitioning off?*

Select all that apply.

Fear of regaining weight

Fear that cravings or appetite will return

Concern about losing progress

Unsure how to maintain results

Concern about energy, muscle, or body composition

Other

2. What is making you consider GLP-1 medications right now?*

Select all that apply.

Difficulty losing weight

Weight regain after previous dieting

Blood sugar or metabolic concerns

Doctor recommendation

Curiosity about whether it may help

Other

3. What concerns do you have about GLP-1 medications?*

Select all that apply.

Possible side effects

Cost

Long-term safety

Fear of regaining weight later

Muscle loss

Unsure if it’s the right approach

Other

2. When did you stop using GLP-1 medication?*

Within the last 3 months

3–6 months ago

6–12 months ago

More than a year ago

3. What led you to stop using it?*

Side effects

Cost

Reached goal weight

Concern about long-term use

Doctor recommendation

Other

2. What side effects did you experience?*

(Select all that apply)

Severe nausea

Constipation

Digestive discomfort

Fatigue

Loss of appetite that felt unhealthy

2. What best describes why you are looking for support without using GLP-1 medications?*

I do not want to use medication

I am concerned about side effects

I am concerned about long-term use

Cost is a concern

I want a different approach

Other

What are your main goals right now?*

Lose weight

Maintain weight loss

Improve metabolic health

Improve digestion

Improve energy

Reduce cravings

Build or preserve muscle

Long-term health and prevention

Are you currently working with a prescribing clinician for GLP-1 medications?*

Yes

Not applicable

Do you have any bloodwork or other health testing completed within the last 6 months related to areas such as gut health, hormones, cortisol and stress, metabolic health, nutrient levels, or food sensitivities?*

Yes — I have testing from the last 6 months

I have testing, but it is older than 6 months

I have both recent and older testing

No, I do not have recent testing

I’m not sure

If you'd like, briefly describe the testing you’ve done and when it was completed (optional)

Example: Bloodwork 3 months ago, stool test about a year ago.

If we decide this is a good fit, what level of investment would feel realistic for you for personalized support?*

Support levels vary depending on individual needs and may include coaching alone or coaching combined with lab-informed services.

Under $500

$500–$1,000

$1,000–$2,500

$2,500+

I understand that by submitting this form, I will be automatically subscribed to the newsletter and can unsubscribe at any time.*

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