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Peri Lean MethodTM Coaching Application Form

Thank you for your interest in the Peri Lean Method™, a 6-month 1:1 clinical nutrition partnership for women navigating perimenopause, menopause and beyond.

This application helps us understand your health history, training, goals and readiness, so we can confirm whether the program is the right fit and which practitioner is best suited to support you. Places are limited, so we only accept women we're confident we can genuinely help.

Please answer as honestly and in as much detail as you can. The more we understand before your discovery call, the more useful that call will be. It takes around 10 minutes to complete.

Click the button below to start.

Start

Question 1 of 25

Please provide your full name (first and surname, as well as preferred name). 

Question 2 of 25

Please provide your best contact email address.

Question 3 of 25

Please provide your best mobile contact number to ensure we notify you that your application has been successfully received and to arrange a discovery call. 

Question 4 of 25

In which city and country do you live, and what is your time zone?

Question 5 of 25

What is your date of birth and current age?

Question 6 of 25

How did you hear about the Peri Lean Method™?

(Select all that apply)
A

Social Media (e.g. Instagram or Facebook)

B

Podcast

C

Referral from a client

D

Referral from a health professional

E

Google, Web or AI (e.g. ChatGPT) Search

Question 7 of 25

Please choose which stage of hormonal transition you are in. 

A

Still having regular periods with no recent changes

B

Periods have changed or become irregular (perimenopause)

C

Postmenopausal (12+ months since my last period)

D

Surgical or medically induced menopause

E

Unsure

Question 8 of 25

What is your main challenge when it comes to your health, managing the midlife transition, performance and body composition?

Question 9 of 25

What prompted you to apply now?

Question 10 of 25

Do you have any current or past medical diagnoses? (e.g. PCOS/PMOS, endometriosis, insulin resistance, thyroid conditions, osteopenia/osteoporosis, high cholesterol, iron deficiency, gut conditions)

Question 11 of 25

Tell me about your menstrual cycle.

If you are still having periods: How many periods do you have per year, and how long is your typical cycle? Has this changed recently? Do you experience heavy or prolonged bleeding, pain, or significant symptoms around your period? Are you using any hormonal contraception (e.g. the pill, Mirena or other hormonal IUD, implant)? 

 

If you are no longer having periods: How old were you at your last period? Was this natural, or due to surgery or medical treatment (e.g. hysterectomy, oophorectomy, chemotherapy)? If you have a hormonal IUD, please note this here.

Question 12 of 25

Are you currently using, or considering, MHT/HRT?

A

Currently using

B

Considering

C

Previously used

D

No

Question 13 of 25

Are you currently using, or considering, a GLP-1 medication? If so, which one and since when?

Question 14 of 25

Do you have a diagnosed eating disorder, or a history of one? 

A

Yes

B

No

C

Prefer to discuss on the call

Question 15 of 25

Describe your current training: type, frequency, how long you've been training consistently, and any competitions or events coming up. Do you have any current injuries, recent surgery or physical limitations that affect your training or daily life?

Question 16 of 25

Which of these have you tried before?

(Select all that apply)
A

Commercial diet programs or apps

B

Online challenges or courses

C

Personal trainer or coach-led nutrition

D

Another dietitian or nutritionist

E

Naturopath or functional medicine practitioner

F

Supplements or testing without clinical guidance

G

Fasting, low carb or keto

H

None of these

Question 17 of 25

What did you find was missing?

Question 18 of 25

By midlife, most women already know a lot about nutrition. What's usually missing is something else. What has stopped you from getting the results you want so far? Be as specific as you can, whether that's time, workload, confidence, consistency or support. This helps me understand whether the Peri Lean Method™ is the right fit for you.

Question 19 of 25

What would need to be different at the end of 6 months for this to have been worth it for you? Be as specific as you can: body composition, energy, symptoms, training performance, confidence.

Question 20 of 25

The Peri Lean Method™ is direct. If something you're doing isn't supported by evidence, or a pattern is getting in the way of your progress, I'll tell you, including on our discovery call. How do you usually respond to that kind of feedback?

A

I welcome it. That's what I'm here for

B

I'm open to it, though I may need time to process it

C

I find it difficult, but I know I need it

D

I'd prefer a gentler approach

Question 21 of 25

How ready are you to start?

A

Just exploring for now

B

Interested, but not ready this quarter

C

Interested, but need to plan timing

D

Keen to start within the next couple of months

E

Ready to start as soon as a place is available

Question 22 of 25

Do you have a practitioner preference?

A

Angelique Clark (APD, SD, EP)

B

Catherine Fallon (APD, ES)

C

Happy to be guided

Question 23 of 25

The Peri Lean Method™ includes 12 sessions (45 minutes each) over 6 months. All sessions must be used within this period, and sessions cancelled with less than 24 hours' notice are forfeited. Can you commit to this?

A

Yes

B

I have questions

Question 24 of 25

With your consent, I collaborate with your GP, specialist or coach where relevant. Are you comfortable with this?

A

Yes

B

Yes with discussion

C

No I prefer not

Question 25 of 25

The Peri Lean Method™ is a 6-month clinical partnership. Please indicate which option you're considering and whether you're in a position to invest at this level:

  • With Angelique: $7,997 upfront, or 6 monthly direct debits of $1,467
  • With Catherine: $3,997 upfront, or 6 monthly direct debits of $733

A

Yes, upfront

B

Yes, payment plan

C

I'd like to discuss options

Confirm and Submit