Lets get your numbers

Height*

4'10 - 5'2 (ft-in)
5'3 - 5'7 (ft-in)
5'8 - 5'11 (ft-in)
6'0+ (ft-in)
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Weight*

150 lbs -190 lbs
191 lbs - 240lbs
241 lbs - 300 lbs
301 lbs +
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What is your weight loss goal?

Lose up to 20 lbs

Lose 21 to 51 lbs

Lose 50+ lbs

I haven't decided yet

What is your motivation for losing weight?

I want to improve my physical health

I want to improve my appearance

I want to improve my mental health

All of the above

When was the last time you had a medical evaluation?

Less than a year ago

1 to 2 years

More than 2 years ago

Do you have any of the following?

These are considered 'co-morbidities' by the American Board of Obesity Medicine. While you may not need to have one of these for treatment, your doctor would like to know.

*

High Cholesterol
Fatty Liver Disease
High Blood Pressure
Pre-diabetes/Type 2 Diabetes/ Hba1c above 5.7
Polycystic Ovarian Syndrome (PCOS)
None of the above
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Are you taking any Prescription medications for weight loss?

None at this time

Wegovy/ Zepbound / Ozempic / Trulicity / Saxenda

Compounded GLP-1

Answer the following about your current medication

1) Name of drug
2) Dose (mg)
3) What is the date of your last dose?

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