Get Pre-Qualified for GLP-1 Treatment

Answer a few questions to see if you qualify for our weight loss program using GLP-1 medications.

What is your weight loss goal?

Lose 1-20 lbs for good

Lose 21-50 lbs for good

Lose 50-100 lbs for good

Lose over 100+ lbs for good

Maintain my current weight

Haven't Decided

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Are you currently taking a GLP-1 medication?

Examples include Ozempic, Wegovy, Mounjaro, Zepbound, etc.

Yes

No

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Do you have a history of any of the following medical conditions?

Select all that apply.

None of the Below

Pancreatitis

Gastroparesis

Type 1 Diabetes

Recent bariatric surgery (less than 6 months ago)

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Are you currently undergoing treatment for an eating disorder?

Select all that apply.

None of the Below

Bulimia Nervosa

Binge Eating Disorder

Night Eating Disorder

Other

Anorexia Nervosa

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Have you been diagnosed with, or do you suffer from, any of the following?

Select all that apply.

None of the Below

Depression or bipolar disorder

Alcohol abuse or substance abuse

History of suicidal ideation or attempts

Anxiety disorder or panic disorder

Other psychiatric condition

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Do you have a personal or family history of medullary thyroid cancer?

No personal or family history of Medullary Thyroid Cancer

Yes, personal history with Medullary Thyroid Cancer

Yes, family history of medullary thyroid cancer

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Do you have a personal history of Multiple Endocrine Neoplasia syndrome type 2 (MEN2)?

No history of MEN2

Yes, I have a history of MEN2

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Do you have a history of Gallbladder Disease?

(does not include gallbladder removal/cholecystectomy)

No history of gallbladder Disease

Yes, I have a history of gallbladder disease

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Are you currently pregnant or expecting to be?

No, I am not pregnant or expecting

Yes, I am pregnant or expecting

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