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Medical Weight Loss

What is your Age?

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What is your Age?

Under 18

18-20

21-30

31-40

41-50

51 or older

What is your weight loss goal?

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What is your weight loss goal?

Loss 1-20 lbs

Lose 21-30 lbs

Loss 31-40lbs

Lose over 40 lbs

Not sure of my goal yet

What is your level of activity?

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What is your level of activity?

I am not active an my diet needs help

I have some healthy habits

I eat well and routinely workout

What is your height?

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What is your weight in pounds?

*

What is your email address?

*

Have you been diagnosed with any of the following?

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Have you been diagnosed with any of the following?

Heart Disease

Fatty Liver

Diabetes or a HgbA1C above 5.7

High Blood Pressure

None of the above

Are you currently taking any medication?

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Are you currently taking any medication?

A

NO

B

Yes

If you are taking medication list them here.

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Have you been on any GLP-1s before?

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Have you been on any GLP-1s before?

Yes

No

Are you ready for evaluation. If so then click below and make an appointment--virtual or in-person. The initial eval is $50 ( labs are not included and insurance is not taken for initial eval) Evaluation will include prior authorization if indicated.