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?
Perfect! With a BMI of , we can continue.
Based on your answers, it appears that you may not be a good fit for GLP-1 treatment at this time.
If you feel this is inaccurate, please review your answers and make any necessary corrections.
Gender
What are your weight loss goals? *
Compounded GLP-1 medications offer effective active ingredients – but at a fraction of the price (80% less) and are more consistently available.
We've been featured on
Elena dropped 52lbs and upped her confidence in only 3 months!
We identify the root causes of your metabolic issues, so you get a long-term solution, not just another quick fix.
What weight loss initiatives have you tried in the past? Select all that apply *
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 *
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!) *
Date of Birth
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. *
Weekly injectable or daily tablet. Reduces appetite and controls cravings naturally. Clinically studied for significant weight loss.
Starting at $197/Month (3-month plan)
Weekly injectable or daily tablet. Dual-action for powerful results. Clinically studied for notable weight loss.
Starting at $297/Month (3-month plan)
You'll get personalized care for your unique biology with prescribed medication, 1:1 physician guidance, and 24/7 Vidamed support with our own dedicated nursing staff.
Your medication price never goes up – even when your dose increases!
Based on your intake form, we recommend Tirzepatide Weekly Injections for the best weight loss results! Just a simple injection once per week.
Note: you can choose whichever medication you prefer, regardless of our recommendation!
Important:
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. *
Drag & drop your file here or click to upload
