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Weight Loss Program Eligibility Check

Please answer the following questions to determine your eligibility for our weight loss program


Height

Weight

BMI (Auto-Calculated)

* Any response outside of “None” may disqualify you from our medical weight loss program.

None

Currently pregnant or actively trying to become pregnant

Breastfeeding or bottle-feeding with breastmilk

End-stage kidney disease (on or about to be on dialysis)

End-stage liver disease (cirrhosis)

Current or prior eating disorder (anorexia/bulimia)

Current suicidal thoughts and/or prior suicidal attempt

Cancer (active diagnosis or treatment)

History of organ transplant on anti-rejection medication

Severe gastrointestinal condition (gastroparesis, blockage, IBD)

Type 1 diabetes

Type 2 diabetes on insulin

Diabetic retinopathy (eye condition related to diabetes)

History of or current pancreatitis

Personal or family history of thyroid cyst/nodule, thyroid cancer, medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2