Effective Online Prescription Weight Loss Treatments

100% Discreet

No Insurance Required

No Photo ID Required

What is your current height and weight?

Please clearly state your height and weight below. *

What is your target weight?

Please enter your desired target weight (number only) *

Do you have any existing medical conditions (e.g., diabetes, hypertension)?

Please describe any and all medical conditions you have. *

Are you currently taking any medications or supplements?

Please list any current medications or supplements you are taking. *

Have you tried any weight loss programs?

Please select one below. *

Yes

Do you have a history of eating disorders?

Do you have a history of eating disorders? *

How often do you exercise, and what type of activities do you engage in?

How often do you exercise, and what type of activities do you engage in? *

What is your typical daily diet like?

What is your typical daily diet like? *

Do you have any food allergies or intolerances?

Do you have any food allergies or intolerances? *

Do you smoke or consume alcohol regularly?

Do you smoke or consume alcohol regularly? *

Do you experience any symptoms related to weight (e.g., fatigue, joint pain)?

Do you experience any symptoms related to weight (e.g., fatigue, joint pain)? *

Have you recently had any significant weight changes?

Have you recently had any significant weight changes? *

Do you have any family history of obesity or related conditions?

Do you have any family history of obesity or related conditions? *

Are you currently pregnant or breastfeeding?

Are you currently pregnant or breastfeeding? *

Do you experience stress or anxiety related to weight?

Do you experience stress or anxiety related to weight? *

Are you willing to make lifestyle changes to support weight loss?

Are you willing to make lifestyle changes to support weight loss? *

Do you have any heart, liver, or kidney issues?

Do you have any heart, liver, or kidney issues? *

How motivated are you to lose weight on a scale of 1-10?

How motivated are you to lose weight on a scale of 1-10? *

Do you have a history of thyroid disorders?

Do you have a history of thyroid disorders? *

Do you have any concerns about using weight loss medications?

Do you have any concerns about using weight loss medications? *

Let's start with the basics

This information helps your doctor determine if you’re eligible for treatment.

First Name

Email *

Phone *

Date of birth

Postal code

I agree to terms & conditions provided by REMI MEDICAL LLC. By providing my phone number, I agree to receive text messages from the business. Your data is 100% secure under HIPAA compliance law. Only your doctor can see this data.