Get
50%
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semaglutide
!
What are your weight loss goals? Select all that apply & click NEXT
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Lose stubborn weight
Fit into smaller clothes
Tighten up loose skin
Boost self-confidence
Other
What areas are you wanting to improve? Select all that apply & click NEXT
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Abdomen
Glutes/Butt
Chin/Neck
Back
Hips/Thighs
Chest (male)
Has previous surgical work been done on these areas? Select one
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Yes
No
It's complicated!
Do you have any of the following medical issues? Select all that apply & click NEXT
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Insulin Resistance
High Blood Pressure
Pancreatitis
Pre-Diabetes
Type 1 Diabetes
Type 2 Diabetes
Hypothyroidism
Hyperthyroidism
No Medical Issues
Other Medical Issues
How many days per week are you physically active/exercising? Select one
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0 Days
1 Day
2 Days
3 Days
4 Days
5+ Days
On those days, how rigorous is your activity/exercise? Select one
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Light
Moderate
Intense
Are you on any of the following diets? Select one
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Keto
Vegetarian
Paleo
Vegan
Other/None
Any questions about this treatment? Select all that apply & click NEXT
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What will my results look like?
How long will it take to see results?
What's the cost?
Is there financing available?
How many injections will I need?
Other
What is your preferred payment method for this treatment? Select one
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Cash
Check
Credit Card
What day would you prefer for your consultation? Select one
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Monday
Tuesday
Wednesday
Thursday
Friday
Please enter your contact details delow.
First Name
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Last Name
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Phone
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