Get Started

  • Patient Information
    First Name:


    Last Name:


    Date of Birth:


    State:


    Email Address:


    Phone Number:


  • Intake Form
    What was the sex assigned to you at birth?




    What is your current weight?


    What is your maximum weight?


    What is your goal weight?


    What is your current height?


    Please select any treatment goals that apply to you


    Do you have or have you ever had any of the following conditions?


    Have you ever been treated or hospitalized for any mental health conditions?







    Are you currently pregnant or plan on becoming pregnant?




    Are you currently using a GLP1 medication?




    Do you currently take any other medications?




    Please list your current medications:


    Do you have any allergies?




    Explain:



    Do you consume alcohol?




    How many drinks do you have on a weekly basis?


    Do you use any recreational drugs?




    What drugs do you use?



    Is there anythng else you would like the doctor to know?



  • Treatment Options
    Semaglutide (Injection)

    Weekly Injection

    Starting at $400.00 / Monthly



    Semaglutide (Oral)

    Daily Oral

    Starting at $400.00 / Monthly



    Terzepatide (Injection)

    Weekly Injection

    Starting at $400.00 / Monthly



  • Order

    Your credit card will not be charged until a doctor has reviewed and approved your case.