Weight Loss

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Please enter a promo code if you have one (Optional)

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What is your height?

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What is your current weight?

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What is your goal weight?

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Have you used an injectable GLP1 medication before?

YESNO

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Which medication have you used?

Mounjaro (tirzepatide)

Wegovy (semaglutide)

Compounded semaglutide

Compounded tirzepatide

Compounded liraglutide

Ozempic (semaglutide)

Saxenda or Victoza (liraglutide)

Trulicity (dulaglutide)

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Do any of the following statements apply to you?

I am currently pregnant or breastfeeding

I plan to become pregnant in the next 3 months

Not applicable to me

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Have you been diagnosed with diabetes?

Yes, I have diabetes and take medication for it.

Yes, I have diabetes and it's diet-controlled.

No, but there is a history of diabetes in my family.

Yes, I have pre-diabetes.

No, I don't have diabetes.

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Have you ever been diagnosed with any of the following?

Active substance abuse or dependency

Currently receiving cancer treatment

Severe heart failure or cardiomyopathy

Chronic kidney disease or severe renal impairment

Liver disease or cirrhosis or Gallblader disease

None of the above

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Do you have any medical conditions that were not listed?

YESNO

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What medical conditions do you have?

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Are you currently taking insulin of any kind?

YESNO

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What medications or supplements are you taking?

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Have you had an allergic reaction of major side effect to any medication?

YESNO

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Please tell us more about the reaction

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Is there anything else you would like to share with the healthcare team?

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Terms and Conditions* This field is required.