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How tall are you?
CmFeet/Inches
How much do you weigh?
Do you have any of the following conditions?
YesNo
Is your age between 18 and 74 years?
If you have type 2 diabetes, are you taking any medications apart from metformin?
Have you ever had an allergic reaction to Wegovy, Mounjaro, Semaglutide, Saxenda, or Liraglutide?
Have you ever been diagnosed with an eating disorder?
Are you currently pregnant, breastfeeding, or trying to conceive?
Have you been diagnosed with or undergone surgery for any serious medical conditions?
Do you or any of your family members have a history of medullary thyroid cancer?
Are you currently taking any medications, including prescription, over-the-counter, or recreational drugs?
Are you on steroids or any thyroid-related medications?
Have you used any injectable weight-loss treatments in the past four weeks?
If applicable, do you understand that you may need to provide proof of a prescription from another provider?
Do you acknowledge that GLP-1 injectable weight loss medications can reduce the effectiveness of oral contraceptives?
Do you understand that this medication is not suitable for individuals trying to conceive?
Are you aware that this treatment may increase the risk of pancreatitis and gallstones?
Do you acknowledge that injectable weight loss medications should not be combined with other weight loss treatments?
If you experience lumps in the neck or voice changes, do you understand you should stop taking this medication?
Weight loss treatments have been linked to mood changes. If you experience depression, do you understand you should seek medical advice?