Rebuild Metabolic Health Institute

The Metabolic Year – 1:1 Mentorship Application

This application is for The Metabolic Year – a 12-month, high-touch 1:1 mentorship focused on hormones, gut, metabolic health, peptides, and longevity.

Investment: $9,000 USD for a full 12-month mentorship, or 12 monthly payments of $825.
The Metabolic Year is designed primarily for graduates of the Unbalanced to Unbroken 12-Week Hormone & Metabolic Rebuild program who want long-term partnership, accountability, and strategic support through all four seasons of change.

1. Applicant Information

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2. Prior Experience with Rebuild Metabolic Health Institute

Have you completed the Unbalanced to Unbroken 12-Week Hormone & Metabolic Rebuild program?

What were your top three wins or changes from the 12-week program (or from work with our clinic, if applicable)?

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

This information helps shape education and strategy. 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 used hormone replacement therapy (BHRT/TRT)?
Have you used GLP-1 medications (for example, semaglutide, tirzepatide)?
Have you used peptide therapies?

4. Current Symptoms & Focus Areas

List up to six core symptoms or patterns you most want to address over the next 12 months:

5. Your 12-Month Vision & Outcomes

If this year of mentorship exceeded your expectations, what would be true 12 months from now?

6. Capacity, Commitment & Support Style

On a scale of 1–10, how ready are you to commit to a full year of implementation and follow-through?

7. Why The Metabolic Year, and Why Now?

8. Scope & Financial Acknowledgement

Please read and initial each statement to confirm your understanding:

9. 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, duration, and financial terms of The Metabolic Year 1:1 mentorship.

Clear Signature
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