Rebuild Metabolic Health Institute

Core Application – Unbalanced to Unbroken 12-Week Hormone & Metabolic Rebuild

This application is for the Core Cohort of the Unbalanced to Unbroken 12-Week Hormone & Metabolic Rebuild program.

Core Investment: $1,500 USD paid in full, or 3 monthly payments of $525.
The Core Cohort includes the full 12-week group experience with weekly live calls, structured curriculum, tracking tools, private group community, a copy of You’re Not Broken—You’re Unbalanced, and program bonuses. This is ideal if you are ready to implement structured changes with expert guidance and community support, without needing additional 1:1 strategy sessions.

1. Applicant Information

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2. Current Health & Care Team (High-Level)

This information helps tailor education and coaching. Do not include full medical records here—detailed decisions remain with your personal healthcare providers.

Are you currently under the care of a primary care clinician?
Are you currently under the care of an OB/GYN, endocrinologist, or other hormone specialist?
Have you ever used hormone replacement therapy (BHRT/TRT)?
Have you ever used GLP-1 medications (for example, semaglutide, tirzepatide)?
Have you ever used peptide therapies?

3. Main Symptoms & Priorities

List up to five core symptoms or problems you most want to improve in the next 12 weeks:

4. Your Goals – 12 Weeks and 12 Months

If this 12-week Core experience exceeded your expectations, what would be true at the end?

Looking 12 months ahead, what are your top three health and performance goals?
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5. Capacity & Readiness

On a scale of 1–10, how ready are you to implement changes over the next 12 weeks (time, energy, and focus)?

6. Program Fit

7. Scope & Financial Acknowledgement

Please read and initial each statement to confirm your understanding:

8. Signature

By signing below, I confirm that the information in this application is accurate to the best of my knowledge and that I understand the scope and financial terms of the Elite program.

Clear Signature
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Travis Woodley

Travis Woodley, MSN, RN, CRNP, is a hormone and metabolic health specialist and author behind Revitalize Medical Clinic, Revitalize Nutrition, Revitalize Aesthetics & Wellness, and the Rebuild Metabolic Health Institute, reshaping how patients and practitioners approach lasting health.

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