Get Started

Your transformation starts here. Every new client needs to submit this info for review by our trained and certified staff to ensure we match you to the right treatment for you.

Discover Our Expertise

We kindly ask all new patients to fill out the medical questionnaire and patient consent form prior to their visit. These forms will help us better understand your medical history and ensure that you are an eligible candidate for your requested services. Please fill out the following form in its entirety.

If you are a current patient and ONLY want to update your address, click here or scroll down to the Update Address form below.

Thank you for your cooperation! We look forward to helping you reach your goals soon.

Patient Information and Consent

Please fill out this form completely.

First Name

Last Name

Email (also used as your Username to login and view invoices)

Password

Phone

Date of Birth

Address (Must be a street address. NO PO BOXES.)

City

State

Zip Code

Height

Weight

Allergies

Medications

Do you or a family member have a history of thyroid cancer?

Do you have a history of pancreatitis?

Have you ever used a GLP1 inhibitor before? (Wegovy, Ozempic, Mounjaro) If yes, which medication and what dose? If you were referred by someone, let us know!

By checking this box you confirm that the information entered is true and that you have read, understand, and agree to the patient consent form in its entirety. VIEW PATIENT CONSENT FORM HERE

Sign Here

Today's Date

5 + 6 =

Update Your Shipping Address

If you only need to update your shipping information, use the form below. This address update form is only for current patients who need to update their shipping information. If you are not a patient yet and want to get started, please complete the entire form above.