How would you describe your current approach to weight management? *

Actively managing

Some efforts

No active efforts

How would you rate your physical activity level? *

Sedentary (I don’t exercise)

Light

Moderate

Vigorous

What dietary plan, if any, are you following? *

None

Minor modification

Significant diestary changes

Are you actually taking a GLP-1 medication such as Ozempic, Wegovy, Zepbound, Mounjaro, Semaglutide, Tirzepatide? *

Yes

No

Current Weight *

Height *

Gender *

Male

Female

Date of birth *

People have different sensitivities to medications and commonly experience side effects to standard dosing regimens. Do you experience side effects to medications and often require lower doses to avoid side effects? *

Yes

No

What medication are you considering? *

Semaglutide

Tirzepatide

I'm not sure

First Name

Email *

Phone *

Address

Street Address *

City *

State *

Postal code *

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