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What is your height?
This form should take around 2 minutes to complete.
Feet (ft.)
(Required)
Inches (in.)
(Required)
What is your current and goal weight?
Current Weight (lbs.)
(Required)
Goal Weight (lbs.)
(Required)
We need some more info from you to build your profile
What state are you located in?
(Required)
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Date of birth
(Required)
Month
Day
Year
Have you used any of the following weight loss medications before?
Semaglutide (Ozempic, WeGovy, Rybelsus)
Tirzepatide (Mounjaro, ZepBound)
Liraglutide (Saxenda)
What Semaglutide dosage were you prescribed? If your dose is not listed, please round up.
(Required)
0.25mg/week
0.5mg/week
1mg/week
2mg/week
2.5mg/week
What Tirzepatide dosage were you prescribed? If your dose is not listed, please round up.
(Required)
2.5mg/week
5mg/week
7.5mg/week
10mg/week
12.5mg/week
15mg/week
What Liraglutide dosage were you prescribed? If your dose is not listed, please round up.
(Required)
0.6mg/week
1.2mg/week
1.8mg/week
2.4mg/week
3mg/week
Do you have any of the following conditions?
Kidney Disease
Type II Diabetes
High Cholesterol
Fatty Liver Disease
Hypertension
|
High Blood Pressure
PCOS
Pancreatitis
MTC
Gall Bladder Disease
Seems like you're a good fit!
Let's create your account. You should be able to join a program immediately afterwards
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