Your Light Wellness Screening Application Form

Physician Screening Application
As a Your Light Wellness and Weight Care Center physician candidate, it is important to understand that:

Your Light Wellness & Weight Care Centers is a virtual wellness and weight care group created to promote health equity in the weight health space. The purpose of this center is to also provide an opportunity for physicians to generate financial freedom and time autonomy by providing complete and compasionate weight care in partnership with affiliate medical companies. Patients will be directed to physicians for weight care assistance based on states of residence. This offer only extends to the physicians and their own mid-level employees (if selected, each physician will have their own clinician portal for revenue and independent patient care purposes).

This application is for the sole purpose of determining appropriateness in providing safe and effective care in licensed states where services are needed. Once the application is completed, the next step is an invitation to interview with our medical director, and then if selected, begin the 1-2 week training and credentialing process.

This is a contracted partnership with the intention of assisting physicians in creating autonomy within their own practice.

Application requirements:
1. BE/BC physician with an unrestricted license to practice in the United States.
2. GLP1-RA prescribing experience preferred, but not required.
3. Not in violation of a non-compete clause (applies to those employed and presently providing telehealth weight loss services only)

Physicians who hold multiple state medical licenses are encouraged to apply.
Do you have an unrestricted medical license to practice in the United States or its territories?*

Yes (please list all that are current with date of expiration)No (Stop here. Please return and complete submission when a license is issued)
If yes, please list states and expiration (include any that have lapsed. n/a if none):*
Full Name*

First NameLast Name and Credentials
List all social media accounts and names used for each account (write 'same' if no different) *
E-mail*
example@example.com
Phone Number:*
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender*
Medical Specialty*
I have prescribed GLP1-RA medications in the past*

YESNO (I am willing to learn)
How many hours a week will you dedicate to your weight care practice?

5-10 hours11-20 hours21-30 hours30+
If applicable, provide the name of your practice/business (n/a if none).*
If applicable, list the number of mid-level employees you have (n/a if none)*
Languages that you're fluent in:*

EnglishSpanishGermanFrenchChineseJapaneseHindiOther
Practice Interests (all that apply)*

GLP1-RA Weight CareWomen's Hormone ReplacementMen's Hormone ReplacementAllergy TestingSupplementsHair Restoration
Are you currently employed?*

Yes (self)Yes (for someone else)No
Are your currently affected by a prior non-complete clause?*

YesNo
If yes, please explain:
Will you need assistance creating or growing your weight care practice?*

YesNo
When can you start?*

MonthDayYear
Describe your experience with metabolic and medical weight care (if any).*
Explain how you know Dr. Toomer*
Provide any questions or concerns? (n/a if none)
Terms & Conditions
Terms & Conditions

By clicking "Submit", I attest that all of the information enclosed with my application is correct to the best of my knowledge.

Your Light Wellness & Weight Care Center is a privately owned organization with the purpose of providing access to safe and effective weight healthcare while assisting physicians create profitable weight care practices.
Are You Human?*
Signature

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**IMPORTANT NEXT STEPS ARE IN THE THANK YOU MESSAGE AFTER FORM SUBMISSION**
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Physician Screening Application

Terms & Conditions