"When nothing else worked... Manelyhood did!"

Are you ready for your next chapter?

With medication, you'll lose 2.02 to 2.7 pounds per week.

It will take about 17.28 weeks to reach your goal weight of 100.

How is that pace for you?

We'll move at your pace.

With GLP-1 medication, your goal to lose 0lbs is easier than you think - and it doesn't involve restrictive diets.

Not a problem, we can move faster.

It will take some work, but with GLP-1 medication, your goal to lose 0lbs can be achieved in about 0 weeks - and it doesn't involve restrictive diets.

Perfect!

Losing 35lbs is easier than you think - and it doesn't involve restrictive diets.

Gallstones Consent:

Use of GLP-1 medications, including semaglutide, tirzepatide, and similar products, has been associated with an increased risk of gallbladder or biliary issues, including the development or worsening of gallstones. If you have existing but asymptomatic gallstones, treatment may increase the chance that these stones become symptomatic, potentially leading to pain, inflammation, or the need for medical or surgical treatment. Notify your provider if you develop new upper abdominal pain, nausea, or vomiting during treatment. Knowing this risk, do you wish to continue?

Cholecystectomy Consent:

You reported a history of gallbladder removal. This medication may still be appropriate but can alter fat and bile digestion, increasing the risk of side effects such as abdominal pain or diarrhea. It may also affect absorption of fat-soluble vitamins (A, D, E, and K); smaller meals, avoiding processed foods, and a daily multivitamin may help. Seek immediate care for severe abdominal pain, fever, or vomiting.

Thyroid Consent

These medications can affect how your body absorbs or responds to thyroid therapy. If you have thyroid disease, your provider may need to adjust your dosage or monitor your thyroid levels more closely after starting treatment.

Are you allergic to any GLP-1 medications such as Ozempic/Wegovy (Semaglutide), Mounjaro/Zepbound (Tirzepatide), Saxenda (Liraglutide), or Trulicity (Dulaglutide)?

Have you taken any weight loss medications in the past 4 weeks?

When did you last take your prescribed weight loss medication?

Because these medications build up gradually in your system, restarting at a high dose after a break can increase the risk of side effects. For safety, we recommend continuing at a lower dose (usually about 50% of your previous dose) and gradually increasing if appropriate. How would you like to proceed?

Since you've been off this medication for an extended period, it's safest to restart at the starter dose and titrate back up. Restarting at a high dose after a break can cause significant side effects, sometimes requiring emergency care or hospitalization. Would you like to continue with a lower starting dose?

What was the approximate date you last injected your GLP-1 medication (please provide month, date, and year)?

Which medication and dose most closely matches your most recent dose?

Are you currently using a brand name medication (like Wegovy or Zepbound) or a compounded version (like semaglutide or tirzepatide)?

To ensure that we have a complete picture of how you're taking this medication, please tell us more about your current dose of the compounded medication. Please check your prescription label or vial and include the concentration (for example, "20 mg/mL") and the amount you take (in units or milliliters, mL).

Have you experienced side effects from your current medication?

Please describe the side effects that you've experienced

How would you like to continue your treatment?

Your needs are unique, and your medicine should be too!

Your GLP-1 medication is personalized to your specific needs

Please select the following options that you are interested in.

Anything else you'd like to share with your provider about your medical history or do you have any questions?

Consent (Compounded GLP-1 and GIP/GLP-1 Receptor Agonist Therapy):

You are requesting treatment with a compounded GLP-1 receptor agonist or GIP/GLP-1 receptor agonist medication, such as semaglutide, tirzepatide, or liraglutide, as part of a medical weight management or obesity treatment plan. These medications work by mimicking incretin hormones that regulate appetite, slow gastric emptying, promote fullness, and improve metabolic health.

Compounded medications are custom-prepared by licensed pharmacists. These formulations may allow for alternative dosing schedules, titration strategies, dosing frequencies, routes of administration, or the addition of ingredients intended to improve tolerability or reduce side effects. Compounded medications are not reviewed or approved by the U.S. Food and Drug Administration (FDA) and are not subject to the same testing, clinical trials, or manufacturing oversight as FDA-approved brand-name products. As a result, compounded medications may differ from FDA-approved products in consistency, potency, efficacy, and safety.

Weight loss medications are typically prescribed for individuals who are obese, or for individuals who are overweight with related medical conditions. Use of these medications in individuals who are overweight without an associated medical condition is considered off-label, meaning the medication is prescribed in a manner not specifically approved by the FDA. Off-label prescribing is a common and accepted medical practice when clinically appropriate and based on medical judgment.

Potential benefits of treatment may include weight loss or weight management, improved blood glucose control, reduced cardiovascular risk, and overall improvement in metabolic health. While many patients tolerate these medications well, they may cause side effects and, in rare cases, serious adverse events including emergency room visits, hospitalization, or death. Common side effects include nausea, vomiting, diarrhea, constipation, decreased appetite, and indigestion. Serious or less common risks include pancreatitis, low blood sugar, gallbladder disease, kidney injury or worsening kidney function, allergic reactions, and gastrointestinal motility disorders such as gastroparesis.

These medications are not safe for use during pregnancy or while breastfeeding, as they may pose risks to a developing baby. The FDA advises the use of additional contraception because these medications may reduce the effectiveness of oral contraceptives. If you use oral birth control, you must continue it with a barrier method, such as condoms, for the first month after starting treatment and for one month after any dose increase. You may choose to switch to a non-oral contraceptive method, such as an intrauterine device or implant, prior to starting treatment. After stopping the medication, you should continue using effective contraception for at least two months to ensure the medication has fully cleared from your system before attempting to conceive.

Ongoing follow-up is required to monitor your response to treatment and to assess for side effects. Medication doses may be adjusted based on tolerability and clinical response.

Please attest to the following confirming that all information you have provided to us is true and complete. I verify that I am the patient and that I have answered the questions asked in this intake form. I confirm that I have reviewed and understood all the questions asked of me. I attest that the answers and information I have provided in this questionnaire is true and complete to the best of my knowledge. I understand that it is critical to my health to share complete health information with my doctor. I will not hold the doctor or affiliated medical practice responsible for any oversights or omissions, whether intentional or not, in the information that I provided.

By proceeding with treatment, you acknowledge that compounded medications are not FDA-approved and may differ from FDA-approved products in safety and effectiveness. You understand the potential benefits, risks, side effects, and pregnancy-related precautions associated with GLP-1 and GIP/GLP-1 receptor agonist therapy, including possible off-label use, and agree to follow prescribed instructions, attend required follow-up, and promptly report any concerns or side effects.

Where should we send your results?

Consent & identity verification

Thank you for your interest

Based on your answers, this treatment isn't a safe fit for you right now. A member of our team may reach out with alternatives.