Just want to make sure... are you interested in using GLP-1 to lose weight and improve the way your body looks? *

Yes

What body type are you coming to us with? *

Average - I look fairly normal I would say

Chubby - I am soft around the edges

Overweight - I am overweight

Extra - More than 50lbs overweight

Which of the following describe your current situation best? (select all that apply) *

I’ve spent years trying diets and exercise plans, but nothing sticks

I’m overwhelmed by food noise, hunger, and cravings, no matter how hard I try to “eat healthy"

I’ve done everything I can to lose weight, but I feel like my metabolism just isn’t cooperating. It’s frustrating and discouraging

I’m starting to worry about my health, not just my appearance

I feel like I'm on a roller coaster of losing and regaining weight. I just want to maintain lasting results without having to feel hungry or tired all the time

I am really uncomfortable in my skin and it's beginning to affect my confidence levels and starting to have a downward spiral on other areas of my life

I want to lose weight, but I also want to feel better—more energy, better sleep, and a healthier relationship with food

How committed are you to solving this problem today? *

5/10 - I don't want to improve my situation that much and I'm OK with not making more progress

7/10 - I'm pretty frustrated with things right now, and want to get them sorted... I know delay just makes time work against me and things will continue to get worse and harder the longer I wait

9/10 - This is effecting my confidence, energy, and how I am showing up in life. I want to fix this ASAP!

10/10 - I will literally do anything to get this situation, I do NOT want to go one day longer without a solution to help me lose weight and make me feel better

Full Name *

Email *

Phone *

What do you know about GLP-1 (the weight loss skinny shot)? *

I’ve never heard of it before and want to learn more.

I’ve heard of it, but I’m just curious right now and not ready to start.

I’ve been on GLP-1 medications before, but I stopped.

I’m on GLP-1 now, and it’s working well, but I want to find a more affordable option.

I’ve done a lot of research about GLP-1 and am ready to start as soon as possible.

I just know about GLP-1 and know it gets results and want to try it

Final health question before we can see if you qualify.... select any health issues you may have below (select ANY and ALL that apply) *

I’m currently pregnant or breastfeeding

I have a history of pancreatitis

I have liver disease

I have kidney disease or reduced kidney function

I have severe gastrointestinal conditions, like Crohn’s disease, ulcerative colitis, or irritable bowel syndrome (IBS)

I have a personal or family history of thyroid cancer (especially medullary thyroid carcinoma) or Multiple Endocrine Neoplasia syndrome type 2 (MEN2)

I have diabetic retinopathy

I’ve experienced severe allergic reactions to medications in the past

None of the above apply to me

LAST STEP: On the next page we will have you schedule a FREE telehealth call to review your quiz results and tell you if you qualify for the GLP-1 weight loss skinny shot. Are you ready? *

Yes - I'm ready to get my results and schedule a call

No - I'm not ready

Can you please let us know why you're not ready below? Because it will help us know what to do if someone else has a similar concern as you. *

Click SUBMIT below to see if you qualify for the GLP1 weight loss skinny shot.