• Medical Weight Management Intake

    Provide your intake details to get started with your weight management plan.
  • Welcome to Simone RX

    Provider-led, personalized care to help you reach sustainable weight goals — safely and effectively.

    At Simone RX, we provide convenient virtual medical weight management through a streamlined telehealth experience designed around your health, your goals, and your lifestyle.

    Our program may include GLP-1 medication support, metabolic health evaluation, medication refills, and ongoing provider-led guidance for long-term weight maintenance.

    Most intakes take approximately 5–10 minutes.

    ✔ Provider-led medical weight management
    ✔ GLP-1 medication support & refills
    ✔ Metabolic health evaluation
    ✔ Ongoing virtual support & follow-up
  • Format: (000) 000-0000.
  • Preferred Communication*
  • What are your goals? (Check all that apply)*
  • What have you tried before? (Check all that apply)*
  • Are you currently taking a GLP-1 medication?*
  • Activity level*
  • Do you have, or have you ever had, any of the following? (Check all that apply)*
  • Are you currently pregnant, breastfeeding, or trying to conceive?*
  • Medication Allergies*
  • Are you requesting a medication refill?*
  • Labs Upload (Optional) — Recent labs or medical records help your provider. Accepted formats: PDF, JPG, PNG. Max 10MB per file.
  • Upload a File
    Drag and drop files here
    Choose a file
    Cancelof
  • Upload a File
    Drag and drop files here
    Choose a file
    Cancelof

  • Schedule Your Visit

    Pick a time that works for you. Times are shown in Eastern Time. Your provider will confirm this appointment.
  • Preferred Visit Date*
     - -
  • Format: (000) 000-0000.

  • Consent & Acknowledgment

    Please review and acknowledge the following statements. All five boxes must be checked to submit your intake.
  • I acknowledge the following statements*
  • Thank You for Your Interest
    Simone RX currently serves patients in Georgia, California, and New Hampshire. We've recorded your interest and will reach out when we expand to your state. For urgent care needs, please contact your local provider.
  • Should be Empty: