BioLocke-Intake

We just need you to answer a few quick questions to confirm you qualify for GLP-1 medications
What is your weight loss goal?
Choose one*

Lose 1-15 Ibs for goodLose 16-50 Ibs for good.Lose 51 + PoundsNot Sure, I Just Need To Lose Weight

NO ONE LOCKS IN WEIGHT LOSS BETTER THAN BIOLOCKE.
BioLocke was juts rated by our customers as the best weight loss medication supplier online.
"I can't thank BioLocke enough. Everything from their product, shipping time, and customer service is unbeatable. I'm down 34 lbs since I started using them 4 months ago!"

- Cam

Great job! Let's keep going.

Next we need to quickly calculate your BMI
Height
Feet*
Inches*
Feet in meter*
Inches in meter*
Total Meters*
Square of height*
Weight(ibs)*
Weight(kg)*
BMI
Sorry, we can’t offer treatment to people with BMI lower than 27

How much experience do you have with GLP-1 medications?
Choose one*

First TimeTried It BeforeCurrently Taking

Real Users, Real Results.

Here ares some of the transformations BioLocke has #lockedin. We take your weight loss journey seriously. Help us... Help you.

Patient Information

Lets get some information so we can set up and prepare your Doctors Appointment!
Name

First NameLast Name
Phone Number
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Email
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