Belly Fat Reduction Clinical Trial Prescreening

1

Participants who qualify receive:

Study treatment at no cost
Compensation for their time and travel expenses
Uber transportation to and from study visits, if needed

2

Are you 18 years of age or older?* This field is required.

Yes

No

3

Please enter your height and weight.* This field is required.

Height (Ft)

Height(Inches)

Weight (Lbs)

4

Total Inches (Do Not Delete)

5

Inches Square (Do Not Delete)

6

Weight Calc (Do Not Delete)

7

BMI (Do Not Delete)

8

BMI Calc (Do Not Delete)

9

Are you dissatisfied with excess belly fat and interested in reducing it?* This field is required.

Yes

No

Not sure

10

In the past 6 months, have you used any prescription or over-the-counter weight-loss medication, participated in a weight-loss program, or used a GLP-1 medication such as Ozempic/Wegovy (semaglutide), Mounjaro/Zepbound (tirzepatide), or Saxenda/Victoza (liraglutide)?* This field is required.

Yes

No

Not sure

11

Have you ever had abdominal liposuction or a tummy tuck/abdominoplasty, or have you had a body-contouring/fat-reduction procedure on your abdomen within the past 12 months?* This field is required.Examples include CoolSculpting/cryolipolysis, Emsculpt, ultrasound fat reduction, laser fat reduction, or fat-dissolving injections.

Yes

No

Not sure

12

Could you come to study visits about twice a month for the first few months, and then about once a month after that? The office is located at 📍 16100 NE 16th Ave, North Miami Beach, FL 33162* This field is required.

Yes

No

13

Calculation (DO NOT DELETE)

14

Thank you very much for participating in this survey. Based on your answers, we believe that you may be ineligible for this clinical trial. However, if you would like a staff member to contact you, please provide your best contact information below.

15

Full Name* This field is required.

First Name

Last Name

16

Email Address* This field is required.

example@example.com

17

Cell Phone Number* This field is required.

Please enter a valid phone number.

18

Best Time to Contact You* This field is required.