GLP-1 Check-In
Share your recent symptoms, adherence, and measurements so your care team can adjust early if needed.
Patient Information
Patient Name
*
First Name
Middle Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Weeks/months since starting GLP-1 therapy
*
Weekly weigh-ins happen on a separate, much shorter form — just the number, takes 15 seconds. This fuller check-in is for the deeper stuff: side effects, protein, strength training, and anything on your mind, and it runs on its own schedule: every 4 weeks while you're titrating, then quarterly once you've passed your efficacy checkpoint. A prospective study found that people who weighed themselves at least weekly were 11 times more likely to hit 5% weight loss at 6 months than people who weighed in less often, so don't skip that quick weekly form even on weeks you're not filling out this one.
Medication Adherence
How many days in the past week did you take your medication?
*
How many doses were missed in the past month?
*
Are you taking or injecting it as instructed, including timing and technique?
*
Yes
No
Digestive Symptoms
For the past 2 weeks, how severe have these digestive symptoms been?
*
Rows
None
Mild
Moderate
Severe
Nausea
Vomiting
Diarrhea
Constipation
Abdominal pain
Did side effects cause you to skip meals?
*
Yes
No
Measurements
Please select all symptoms you have experienced:
*
Severe abdominal pain
Vision changes
Signs of gallbladder issues (pain after fatty meals)
Signs of dehydration
None of the above
Current weight (lbs)
*
Starting weight (lbs)
*
Waist circumference (inches)
How often have you weighed yourself since your last check-in?
*
Daily
A few times a week
Once a week
Less than once a week
Not at all
How does your rate of weight loss feel to you?
*
About right
Slower than I expected
Faster than I expected
Not applicable / no change yet
Protein Intake
Getting enough protein — about 1.2 to 1.3 grams per kilogram of body weight per day — helps preserve muscle while you lose weight on a GLP-1. Without it, more of the weight lost tends to come from muscle instead of fat, which matters especially as estrogen decline already puts you at risk for muscle and bone loss.
Are you consistently hitting a high-protein target at most meals?
*
Yes
No
Not sure how to tell
Strength Training
Resistance or strength training at least twice a week is one of the best ways to protect muscle and bone while losing weight — this matters even more during perimenopause and menopause, when muscle and bone loss already accelerate.
Are you doing resistance or strength training at least twice a week?
*
Yes
No
What's getting in the way? (time, access to equipment, not sure where to start, etc.)
General Activity
Weekly activity minutes (all types combined)
*
Are you drinking enough water?
*
Yes
No
Questions or Concerns
Do you have any concerns or questions for your care team?
Progress Tracking
We recommend tracking your progress in a way that helps you see changes over time — especially in the first 1-2 months when the scale may not move much. Option 1: Use an app like MeThreeSixty (about $4.99/month) to create a 3D body scan and compare over time. Option 2: Take free progress photos (front, side, back) every 2-4 weeks in the same clothing, lighting, and spot. You may notice changes in body shape and how clothes fit before the scale changes — that's normal.
How are you tracking your progress?
*
App-based body scan
Progress photos
Scale only
Not tracking additional progress
If you're experiencing severe or persistent abdominal pain, vision changes, or other signs of a medical emergency right now, do not wait for us to review this form — go to the nearest emergency room or call 911 immediately. This form is reviewed periodically, not in real time, and is not a way to reach us urgently.
Safety Check
Submit Check-In
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