Instructions

Thank you for your interest in learning more about whether GLP-1 receptor agonist therapy is right for you. Please fill out the information and questions below, and I will review your results and respond personally within 72 hours. Talk to you soon!

Are GLP-1 Receptor Agonists Right For You?

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

What was your gender assigned at birth?

Male

Female

What is your age?

Under 40

Over 40

Do you identify as a person of color?

Yes

Have you ever been told by a healthcare provider that you are overweight or obese?

Yes

Have you been diagnosed with type 2 diabetes or prediabetes by a healthcare provider?

Yes

Have you been diagnosed with any of the following cardiovascular conditions? (Check all that apply)

High blood pressure

High cholesterol

I have had a heart attack before

I have had a stroke before

Do you currently have a personal weight loss goal of 30 pounds or more?

Yes

Comments

If there is anything else you think I should know, please include it here. Thanks!

Disclaimer(Required)

The information provided to address your eligibility for a GLP-1 receptor agonist is meant for educational purposes only. My review of your responses are not intended to serve as medical advice and should not be used for the diagnosis or treatment of a health problem or disease. Any content provided on this website is not a substitute for medical care.

Yes, I have read the disclaimer and agree to the terms stated.