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Initial Screening
Let's get you qualified!
7
Questions
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1
Do you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC)?
*
This field is required.
YES
NO
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2
Type a qDo you or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)?uestion
YES
NO
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3
Have you had a serious allergic reaction to semaglutide or any of its active and inactive ingredients?
(eg. Active Ingredient: semaglutide Inactive Ingredients: disodium phosphate dihydrate, propylene glycol and phenol)
YES
NO
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4
Are you pregnant or plan to become pregnant?
YES
NO
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5
Are you breastfeeding or plan to breastfeed?
YES
NO
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6
Do you have a history of diabetic retinopathy?
YES
NO
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7
Do you have or have had severe injury/problems with your pancreas or kidneys?
YES
NO
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