Before we dispense your GLP-1 medication for the first time, Luke or Lisa will personally review the information you provide. This helps us understand your medications, health history, goals, nutrition and current activity level so we can help you begin treatment safely and confidently.
GLP-1 medications can be powerful tools, but successful treatment involves more than simply losing weight. Our goal is to help you manage potential side effects, get the nutrients your body needs and protect your muscle, strength and long-term metabolic health while taking the medication.
✅ A comprehensive review of your prescription medications, OTC medications and supplements.
✅ A GLP-1 safety review, including your health history, other medications and potential risk factors.
✅ Practical guidance about what to expect, common side effects and when to contact your pharmacist or prescriber.
✅ A personalized plan to support adequate protein and amino-acid intake, hydration and digestive health.
✅ Recommendations for resistance training and other healthy habits that can help preserve muscle and strength during weight loss.
✅ A one-on-one pharmacist consultation to answer your questions and help you get the greatest possible health benefit from your treatment.
💊 Please have your prescription medications, OTC medications and supplements nearby—including the name and prescribed dose of your new GLP-1 medication.
🧪 If easily accessible, have your most recent lab results available.
⏱ Plan for approximately 10 minutes to complete this questionnaire.
📝 Answer as completely as possible. The more information you provide, the more personalized and valuable your consultation will be.
We’re excited to help you use this medication as one part of a complete plan to improve your health—not just to lose weight, but to become healthier, stronger and more metabolically resilient.
Please list every prescription medication you currently take
Please list every vitamin or supplement you currently take even if only occasionally.
Please list every over the counter medication (excluding the vitamins/supplements you already listed) you currently take even if only occasionally. i.e. Ibuprofen, Claritin etc.
Help us understand what you'd like to improve and what you're currently experiencing.
Your Daily Habits
These questions help us understand the habits that may be affecting your energy, metabolism, and overall health.
Recent Blood Work
If you've had blood work completed within the last 12 months, we'd love to review it before your consultation. *This is not mandatory
If you are unable to upload or would rather just enter your information manually you can do so below.
Please review and acknowledge the following terms before signing and submitting your health assessment.
1. Scope of Consultation This medication review and corresponding consultation that will be done is based solely on the information provided by the patient (or their authorized representative) at the precise time of the review. The recommendations, insights, and information provided herein are strictly limited to this data. Nothing further is to be assumed, implied, or accepted.
2. Accuracy of Information The customer acknowledges that the information they provided forms the entire basis of this consultation. As a result, there may be missing, incomplete, or erroneous information regarding the customer’s medical history, current medications, allergies, or health status. The pharmacist assumes no responsibility for verifying the completeness or accuracy of the information provided by the customer.
3. Limitation of Liability & Hold Harmless By accepting this consultation, the customer expressly acknowledges and agrees to hold harmless, blameless, and free from fault the reviewing pharmacist, the pharmacy, and its affiliates from any and all liability, claims, damages, or demands. This includes, but is not limited to, adverse reactions, drug interactions, or omissions resulting from incomplete or inaccurate information provided during the consultation.
4. Not a Substitute for Primary Medical Care This consultation is intended for informational and educational purposes to assist the customer in managing their medications. It does not constitute a comprehensive medical diagnosis and should not replace regular consultations with your primary care physician or prescribing doctor.
Appointment & Consultation Updates (Recommended) I agree to receive appointment reminders, consultation updates, and important notifications by text message. By checking this box, I agree to receive SMS messages from Luke's Pharmacy & Wellness regarding my My Pharmacist Consult, appointments, wellness updates, medication notifications, and customer support. Message frequency varies. Msg & data rates may apply. Reply STOP to opt out or HELP for assistance. Consent is not a condition of purchase.
Wellness Tips and Promotions (Optional) I would like to receive wellness tips, special offers, and educational content. By checking this box, I consent to receive marketing and promotional messages including special offers, discounts, new product updates among others, from Luke's Pharmacy & Wellness at the phone number provided. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.
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