Card Form Semaglutide Eligibility (LIVE English)

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Please fill out our intake form to ensure treatment eligibility and schedule your intake appointment.An easier, faster way to lose weight is only a few clicks away.
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What should we call you?* This field is required.
First Name
Last Name
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It's nice to meet you, {Whatshouldwecallyou:first}! Where can we send appointment and medication updates to?* This field is required.We won't ever sell your information
4
What state do you live in?* This field is required.Please make sure you live in one of the states we are able to provide care in
Please Select
Please Select
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Delaware
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5
What concerns have brought you here today?* This field is required.
I've tried to lose weight without success
I am worried about my health
I want to look better
I want to feel better
I want to live longer
I want to lose weight to address chronic health conditions
Other
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Break the cycle. It's not easy to lose weight. We are here to help.Losing weight just doesn't come down to willpower and doing all the right things. For some, underlying factors like genetics and hormones make it more difficult than it should be.
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Have you used weight loss medication in the past?* This field is required.
Yes
No
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Semaglutide helps you feel fuller fasterIt slows down your metabolism. Thus, you are feeling fuller quicker and will likely not overeat.
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How much weight do you want to lose?* This field is required.
5-10 lbs
10-30 lbs
30-50 lbs
50+ lbs
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We're excited to help you reach your goal.

Our medications are clinically proven to help you lose 20% or more of your starting weight in under 6 months.
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Please calculate your BMI * This field is required.Please note that our medications are for those with a BMI of 25 or higher
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STOP! Your BMI must be equal to or greater than 25 to continue. Please ensure your submission is correct.
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Do you have any of the following conditions?
Type 1 Diabetes
History of pancreatitis
Personal or family history of medullary thyroid carcinoma
Pregnant or breastfeeding
None of the above
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Sorry, based on your responses you are not eligible for treatment. For more information please contact us at hello@joymd.com
I understand
15
Great, based on the answers to our preliminary questions you are eligible for treatment.
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Next Steps

1. Complete Payment

2. Schedule Appointment

3. Meet your provider and get medication sent to your home
17
Check Out Enter JOYMD24 to save $100
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ORDER SUMMARY
Total costUSD
Semaglutide Medication for Weight LossHome delivery of Semaglutide Medications subscription. 1st month $199, $299 every month thereafter with launch offer coupon "JOYMD24". Free 2-day shipping. Free consultation with licensed provider. Cancel anytime.
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We're happy you're here.

We're excited to help you reach your goal.

Our medications are clinically proven to help you lose 20% or more of your starting weight in under 6 months.

STOP! Your BMI must be equal to or greater than 25 to continue. Please ensure your submission is correct.

Great, based on the answers to our preliminary questions you are eligible for treatment.

Next Steps