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Get Started On Your Weight Loss Journey

Complete the steps below


STEP 1 OF 5

STEP 2 OF 5

Gender (at birth) *

STEP 3 OF 5

Are you currently taking any medication? *

Do you have any medical conditions, past or present? *

Are you taking semaglutide currently? *

Are you currently taking any diet medication? *

Do you have any medication allergies? *

How often do you consume alcohol? *

What is the primary reason(s) that you are seeking weight loss treatment and what are your goals about weight control and management at this time? *

STEP 4 OF 5

Do you have or have you ever had any of the following conditions? (Check all that apply) *

Do you have a history of any of the following? *

Yes No
Medullary Thyroid Cancer
Multiple Endocrine Neoplasia
Pancreatic Cancer
Type I Diabetes

Do you have any other health problems or medical conditions not listed above? *

Are you pregnant or trying to get pregnant? *

STEP 5 OF 5

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