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BlueRidge Eligibility

Please answer a few questions so that our providers can
review and respond with your personalized eligibility!
Your email*
example@example.com

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What is your name?
First Name*
Last Name*

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What is your date of birth?
Enter your age*

MonthDayYear
Date

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What is your height & weight?

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We are sorry, but based on your response to our survey you are not a candidate for GLP-1’s on our platform at this time. We recommend that you follow up with your primary care physician for more appropriate options. Thank you for choosing Blueridge Meds!

Congratulations!

Based on your responses, it is likely that a medical professional will recommend a GLP-1 medication plan for you.

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What is your phone number?
Phone Number*
Please enter a valid phone number.

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What state do you live in?
State*

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We are sorry, but based on your response to our survey you are not a candidate for GLP-1’s on our platform at this time. We recommend that you follow up with your primary care physician for more appropriate options. Thank you for choosing Blueridge Meds!

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What is your birth-assigned gender?
Please select your birth-assigned gender*

MaleFemale

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Are you currently on weight loss medication?
Please select your answer*

YesNo
What medications and dose have you been on?*

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Tell us what’s most important to you?
Select all that apply*

Losing weightIncreasing confidenceImproving another health conditionImproving physical healthEstablishing healthier habits

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