GLĒO Wellness Eligibility Assessment

1
Do you currently live in Massachusetts?* This field is required.*GLĒO Wellness currently provides telemedicine weight care only in MA.
Yes
No
2
Your age* This field is required.*Our program is designed for individuals 18 years and older.
3
What sex were you assigned at birth?* This field is required.
Male
Female
4
Are you currently pregnant?* This field is required.
Yes
No
5
Are you Asian?* This field is required.*BMI cut-off for program eligibility are different for individuals of Asian descent.
Yes
No
6
What is your height and weight?* This field is required.After entering your current height and weight, please copy your BMI result below—you’ll need to paste it on the next card. Thank you!
7
Your BMI* This field is required.Kindly paste your BMI result in the box below to continue. Thank you!
8
Do you have any of the following conditions?* This field is required.*Please select all that apply.
Cardiovascular Disease
Dyslipidemia
Hypertension
Metabolic Associated Fatty Liver Disease (MAFLD)
Metabolic Syndrome
Obstructive Sleep Apnea
Polycystic Ovary Syndrome (PCOS)
Pre-Diabetes
Type 2 Diabetes Mellitus
None of the above
9
You qualify for GLĒO Wellness Telemedicine Weight Care Program’s lifestyle interventions (nutrition, physical activity, and behavior modification). Based on your lab results, medication may also be recommended as part of your care plan. Would you like to proceed?* This field is required.
Yes
No
10
How motivated are you to make changes to your nutrition, physical activity, and daily habits to support your weight and health goals?* This field is required.
Very motivated
Not very motivated
Somewhat motivated
Not motivated at all
11
Are you willing to participate in monthly virtual visits with your weight care specialist as part of this program?* This field is required.
Yes, I am willing to participate in monthly visits
I am unsure
No, I am not willing
12
How ready are you to start making changes to your lifestyle (nutrition, physical activity, and behavior) in the next month?* This field is required.
Ready to start now
Not ready yet
Planning to start soon
13
Congratulations! You qualify for GLĒO Wellness Telemedicine Weight Care Program. Please click the submit button to continue with your next steps.
14
Thank you for your interest in GLĒO Wellness Telemedicine Weight Care Program. If you have questions or would like to discuss other options, please contact our team at hello@gleowellness.com.
15
Sorry, you are not eligible for GLĒO Wellness Telemedicine Weight Care Program based on your responses. If you have questions, please contact our team at hello@gleowellness.com for more information.
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