Value Med - GLP1 Quiz

Name*

First NameLast Name

Cell Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Birthdate*

Date

Gender*

MaleFemaleN/A

What state do you live in?*

Have you tried other weight loss programs in the past? (Select all that apply)

Surgery (such as lap band and other stomach surgeries)Point Counting Programs (such as Weight Watchers, Noom, etc)Meal Plan Services (Nutrisystem, Hello Fresh, etc)Exercise (Running, Gym Membership, Personal Training)Other

What is your primary motivation for losing weight? (Select all that apply)

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