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Eligibility
GLP

Reach your goal weight without restrictive diets and exercise. Let's calculate your BMI to make sure you're a good candidate for medical weight loss. What is your height?

Please enter a number greater than or equal to 1
Please enter a number from 0 to 11
Trusted

What are your weight loss goals?

It feels like magic, but it's metabolic science.
GLP
On average, GLP-1 patients lost 18% of their body weight.

Compounded GLP-1 medications offer effective active ingredients – but at a fraction of the price (80% less) and are more consistently available.

What weight loss initiatives have you tried in the past? Select all that apply *

"Nothing has worked like this. I am down 25lbs in 5 weeks. I've never experienced anything like it. I have more energy and confidence than I've had in years!"

GLP

Elena dropped 52lbs and upped her confidence in only 3 months!

How will GLP-1 work for you?

GLP
  • Week 1 - 4 : Your body gets acclimated to GLP-1 medication
  • Week 4 - 8 : Weight loss is increasing more and more
  • Week 9+ : Your body has become a burning machine

We identify the root causes of your metabolic issues, so you get a long-term solution, not just another quick fix.

Are you currently taking any GLP-1 medications? *

Are you currently pregnant, breastfeeding, or planning to become pregnant within the next 2 months? *

Do you have any of the following conditions? Did you have any in the past? (Select any that apply.) *

Please check all current or past medical conditions. Select all that apply *

Do you have any allergies? (If none, just type “N/A.”) *

List any surgeries you have had in the past: If you haven't had any surgeries, type N/A *

Which type of consultation do you prefer? (Let us know what works best for you!) *

Please review and attest to the following before continuing.
Consent: I confirm that I am the patient completing this intake form and have reviewed all questions carefully. I attest that my answers are true, accurate, and complete to the best of my knowledge. I understand the importance of providing my doctor with complete and accurate health information for my care. *

Please confirm that all the information you've provided is true and complete. Consent: I confirm that I am the patient completing this intake form and have reviewed all questions carefully. I attest that my answers are true, accurate, and complete to the best of my knowledge. I understand the importance of providing my doctor with complete and accurate health information for my care. *

Note: All options include personalized compounded medication as prescribed by your doctor, all necessary supplies, ongoing medical support, and free nationwide shipping.

Important:

  • You will only be charged if the doctor approves the medication. If you do not qualify, no charge will be made.
  • Vidamed does not auto-charge. Your card is securely stored in the portal so you don't have to re-enter it
  • For Monthly plans: you're charged the first month price. Subsequent months are charged at regular price only after your approval.
  • For 3-month plans: it's a single upfront payment of the total amount.
  • You will always receive text/email reminders to approve future refills.
GLP

Billing Information

Please upload a government-issued photo ID We use this only to verify your identity and protect your information. Foreign government IDs, such as a Mexican ID, are accepted. *

You may upload any government-issued photo ID, including a driver's license, passport, state ID, or foreign government-issued ID, such as a Mexican ID.
GLP

Are you currently taking any medications, including prescriptions, over-the-counter meds, or supplements? If yes, please list them here! (The more details, the better!) *

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