Consult Request @ Infusalounge Wellness Spa Logo
  • Thank you for choosingΒ InfusaLoungeΒ for your weight loss solution!Β 

    You can initiate a refill each month at your own pace!

    Β Β SHIPPING TO ALL OF TEXAS!

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    Refer 3 Friends and receive $200 your next Refill!

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    Join our FB Group and share your progress! You could win a $50 gift card to Lululemon, Amazon or More!

    InfusaLounge Wellness Semaglutide & Tirzepatide Support Group!

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    It is simple to get started and schedule your consultation with our provider.

    1. Complete the health questionnaire.

    2. Take a picture of your driver's license and upload it.

    3. Take a picture of yourself (this is for your protection) and upload it.Β 

    4. Pick a date and time of day you would like the practitioner to call you.

    When you submit the form, your card will be charged for the script and Consultation.Β 

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    Β We suggest a minimum of 3 Mo for up to 20lbs +

    We have a discount on Step Therapy since multiple vials are shipped in one shipment.

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    After submitting your information, please complete the payment details.

    *Please Note: If your submission is not approved by the provider, we will refund your payment within 48-72 hrs!

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    Β  Β  Β  Β Β ** WE DO ACCEPT CareCredit, HSA & FSA CARDS**

    For CarecCredit transactions, please call the spa at

    972-546-4318

    All syringes and needles are included in the program.Β 

    The medical provider will attempt to call 2 times.Β If you want to change the date or time, please email us at: scheduling@infusalounge.com

    Β  Β  Β  Β  Β  Β  Β  Β  Β  Β  Β Β We are excited to see your results!

    Please note the address you enter will be where your medication is shipped.

    We will only ship after the consultation and payment has been received. You should receive your medication within two days.Β 

  • Patients Details

    Complete all sections of the form below.
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  • Semaglutide & Tirzepatide is contraindicated in patients with a personal or family history of certain types of thyroid cancer, specifically thyroid C-cell tumors such as medullary thyroid carcinoma (MTC), or in patients with multiple endocrine neoplasia syndrome types.

  • TELEMEDICINE PATIENT CONSENT PURPOSE: The "Telemedicine Consent Form" aims to get the patient's consent to participate in telemedicine appointments with the provider. RECORDS: Telecommunications with patients will not be recorded and stored. Patient's medical information obtained by the diagnosis and analysis can be used anonymously for further improvements in scientific studies.

    TELEMEDICINE INFORMATION: The medical information related to the patient's history, records, and tests will be discussed during the telemedicine appointment with video and audio. ACCESS: The patient accepts that he/she needs access to PC, laptop, or mobile device and a good internet connection in order to have an efficient telemedicine appointment.

    PATIENT RIGHTS: The patient can withdraw his/her consent at any time and can ask questions related to telemedicine appointments and technical requirements for telecommunication.

    By signing this form, I understand that all the laws that protect my privacy of medical history or information are also applied to telemedicine practices. I understand that I can withdraw the consent at any time, which will not affect my future treatment procedures. I understand that I can be charged additional fees that my insurance does not cover. I accept that I authorize health care professionals and use telemedicine for my treatment and diagnosis. ** All Sales are Final - No Refunds will be processed unless you are not a candidate for the therapy.** The Pharmacy will not take the Medication back.

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