Priority onboarding for expediated doctor review

Initial Assessment

This short questionnaire helps determine if our Metabolic Protocol might be appropriate for you.

Information provided is used only for eligibility review.

First Name *

Last Name *

Date of birth *

Sex *

Male

Female

Height (ft/in): *

Ex: 5

*

Ex: 11

Current Weight (lbs): *

Ideal Weight (lbs): *

How can we reach you?

Best Email: *

Phone: *

By checking this box, I consent to receive messages related to clinical services I have requested. Reply HELP for help or STOP to opt out.

How long have you tried losing weight consistently? *

Less than 6 months

6-12 months

About 2 years

3 years or more

Instead of fighting your mind and body, we work with it...

For eligible individuals, clinicians help reset appetite signaling to stop food cravings safely.

Straightforward systems help integrate habits that make weight loss sustainable even after treatment is complete.

When would you ideally want to begin treatment, if eligible? *

As soon as possible

Within the next 30 days

Later this year

If approved, which option best reflects how prepared you are to approach treatment? *

I'm open to premium coaching with accountability & personalized support with a dedicated Protocol Advisor.

I'm prepared to invest in a structured monthly program in the $600-$800/mo range with clinical treatment included.

I'm able to invest $3-5K upfront and fully commit to achieving sustainable weight loss with the right protocol.

I'm not willing to invest at this time but still curious.

Do any of the following conditions apply to you? *

History of severe hypersensitivity reaction (anaphylaxis or angioedema) to GLP-1 medications.

Personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia type 2 (MEN2).

Currently taking diabetes medications such as glipizide, glyburide, Jardiance, or similar medicines for type 2 diabetes.

History of pancreatitis (inflammation of the pancreas) diagnosed by a medical provider.

Currently being treated for type 2 diabetes with insulin.

None of the above

If you are unsure, select none for the initial assessment.

Any other medical conditions you want us to be aware of?

Address

Street Address

City

State *

Postal Code

Please confirm the following: *

I understand this is a medically guided process and outcomes vary based on individuals.

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