Let’s See If This Program Is Right for You

To make sure you receive the right level of care and support, please answer a few quick questions. This short pre-screener helps us determine if our medically supervised programs are the best fit for your current health needs.

It only takes a minute — and helps us provide the safest, most effective experience possible.

Full Name

Email

Phone

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

1. Have you ever been diagnosed with any of the following: *

Bulimia nervosa (current or past)
Anorexia nervosa (current or past)

2. Are you currently: *

Pregnant
Breastfeeding
Actively trying to become pregnant within the next 6 months

3. Do you currently use recreational drugs such as cocaine or methamphetamines? *

4. Have you or an immediate family member (parents, siblings, children) ever been diagnosed with: *

Medullary thyroid cancer (MTC)
Multiple Endocrine Neoplasia Type 2 (MEN-2)

5. Have you ever had: *

Gallbladder disease
Pancreatitis
Gallbladder removal within the last 2 months (especially due to pancreatitis)

6. Are you currently taking any of the following diabetes medications: *

Insulin
A GLP-1 medication
A sulfonylurea medication (e.g., glipizide, glyburide)

7. Do you have: *

Triglycerides higher than 500 mg/dL (fasting)
Current Warfarin (Coumadin®) use

If yes, please explain

8. Have you had bariatric (weight-loss) surgery within the past 12 months? *

9. Is your current BMI 25 or higher? *

If No, the medical provider will require you to upload a recent body fat scan or a medical record showing a higher past weight at the time of final review.

10. Are you willing to commit to medical supervision, nutrition guidance, and follow-up appointments as part of this program? *

Note: Your answers help us understand your fit for the program, but they do not guarantee eligibility.
A licensed provider will make the final decision after reviewing your full medical intake.

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