Fluent Form – JoinMedify

Height (feet)

Height (inches)

Weight (pounds)

Your BMI Score is:

Date of birth

Sex assigned at birth

Are you currently taking or have recently (within the last 12 months) taken a GLP-1 medication?

Yes

No

Have you ever been diagnosed with obesity (bmi > 30) or overweight (bmi >27)?

No

Yes, overweight

Yes, obesity

How would you like to kick-start your journey?

Order meds without visit

Schedule video visit

Choose between first video visit or order medication directly. Flexibility is key; feel free to switch options as your treatment progresses!
Whether you are looking for branded meds or compounded, you may choose either option above!

Begin filling out your request form

Please indicate any relevant medical history or conditions from the following list

Drug or Alcohol Misuse

History of thyroid issues or cancer in you or your family?

Tumor or infection in your brain or spinal cord

Elevated resting heart rate or a diagnosis of tachycardia

Coronary artery disease, stroke, or recent heart attack

History of congestive heart failure

Recent hospitalization within the last 12 months

None of the above.

What is your current or average blood pressure range?

<120/80 Normal

120-129/<80 Elevated

130-139/80-89 High stage 1

≥140/90 High Stage 2

What is your current or average heart rate range?

<60 bpm Slow

60-100 bpm Normal

100-110 bpm Slightly fast

>110 bpm Fast

Are you currently taking, plan to take, or have recently taken opiate pain medications and/or opiate-based street drugs? (within the last 3 months)

Yes

No

Are you currently taking or have previously taken medication(s) for weight loss?

Yes

No

1. Choose an available day:

The highlighted dates are the available ones

Available times

Select Product

Tell us about yourself

Begin filling out your request form

1. Choose an available day:

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