Weight Loss Journey
Step1: Medical Compatibility Form & Waiver
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Birth Day *
Height
Weight (lbs)
BMI
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Semaglutide & Tirzepatide
a.k.a Ozempic & Mounjaro (GLP -1 Agonist)
Compatibility Form & Waiver
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Are you sure your birthday is January 3, 2023? Please confirm your birthday below:
Please enter your phone number one number at a time starting from the area code. For example: 321 456 7891, don't worry about adding spaces. No need to add the country code (+1) either.
Birth Day *
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Height
Weight (lbs)
BMI
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Weight History
How much did you weigh...
Medical History
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Patient Waiver Acknowledgement and Signature
Patient Signature
Patient Full Name
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