YourMD Intake Weight Loss (GLP-1)

Let's get started

A few basics. Your physician will use this to verify your identity and jurisdiction.

First name

Last name

Date of birth

Sex at birth

Phone

State of residence

Medical history

Check all that apply. Your physician will review these and may follow up for details.

Current medical conditions

High blood pressureDiabetesHeart diseaseHigh cholesterolThyroid disorderKidney diseaseLiver diseaseDepression/anxietyPancreatitisGallbladder diseaseCancer historyNone of the above

Known drug or food allergies

PenicillinSulfa drugsNSAIDsLatexShellfishNutsNone

Current medications (list each one on a new line)

Treatment specifics

Tell us about your goals so the physician can tailor a plan.

Current weight (lbs)

Height (inches)

Weight loss goal (lbs) Have you tried GLP-1 medications before? Is there anything else your physician should know?

Review & submit

Confirm your answers and accept the terms below. Your intake goes straight to a board-certified physician.

I agree to the Terms of Service, Privacy Policy, and Prescribing Disclosure. I understand YourMD physicians will review my intake and may decline to prescribe based on clinical judgment. I confirm I am at least 18 years old and that the information I have provided is accurate to the best of my knowledge.

Your intake is in review

A board-certified YourMD physician will review your intake and reach out within 24 hours.

One more step: create your patient account so you can message your physician, track your treatment, and get notified the moment your plan is approved.

Create my patient account

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