Appointment intake

Autosaved as you go - you won't lose information between steps.

Step 1 of 7
If unchecked, progress is saved only for this browser session (recommended on shared devices).
Support
Questions? Contact support anytime.
Contact Support

Contact information

We'll send appointment updates and next steps to these details.

~1 minute
Please enter your first name.
Please enter your last name.
Please enter a valid email.
Please enter your phone number.
Sample ID format
Sample driving license ID format
Example only. Upload a clear photo of your own valid government ID.
Upload your driving license or any government-approved photo ID to continue.
Please upload your driving license or government-approved photo ID.
By continuing, you agree to receive messages about your appointment and account. Standard messaging rates may apply.
Licensed
Every case is reviewed by a licensed medical provider.
Private
Your data is protected and used only for your care journey.
Fast
Most patients complete intake in under 7 minutes.

Eligibility basics

This helps us match you with the right appointment path.

~1 minute
Please select your state.
Please enter a valid age (18+).
Please enter your height.
Please enter your weight.
Body Mass Index (BMI)
-- kg/m2
Enter height and weight
We will calculate your BMI automatically.
Underweight
< 18.5
Healthy
18.5 - 24.9
Overweight
25 - 29.9
Obesity
30+
BMI is a screening measure, not a diagnosis. Your provider uses full clinical context.
Please choose a goal.

Health history

Your provider uses this to evaluate safety and fit.

~2 minutes
Please enter your current medications (or write "none").

Weight loss goals

Helps your provider personalize your plan and expectations.

~2 minutes
Please select an option.
Please select an option.
Please tell us your target outcome.
What progress can look like
Interactive projection based on your consistency level.
Illustrative only
Current consistency: 80%
Estimated weight trend over 12 weeks
At this consistency, many patients can see a meaningful early change by week 12.

Choose a treatment option

Select the option you're interested in. A provider will confirm what's clinically appropriate.

~1 minute
Important: This selection does not guarantee a prescription. Final decisions are made by your licensed provider after medical review.
Patients trust this process
Real feedback from completed programs

"I finally had a plan I could stick to. The intake and follow-up were very clear."

- M., Texas

"I felt supported from day one and saw progress without extreme dieting."

- R., Florida

"The provider explained everything simply. Booking was easy and fast."

- A., California
Before and after snapshots
Program transformation example one
12-week progress example
Program transformation example two
16-week progress example
Results vary by individual and medical profile.
Phentermine
Short-term appetite support (when clinically appropriate)
Phentermine dosage price
Tirzepatide
Ongoing program option (when clinically appropriate)
1 Month Full Package with B12
3 Month Full Package with B12
Please select one option to continue.
Confirm your selection
No selection yet.

Appointment preferences

Choose how you'd like to schedule your visit.

~1 minute
Please choose a scheduling option.
Connect now
This is where you can route the user to your immediate connection flow (video room / call queue / live chat).
Connect Now
Tip: your backend can assign a provider and return a secure meeting link for this user.
Your preferred appointment times
Select a preferred day.
Select a preferred time window.
Select a timezone.
Book your appointment
Select a date/time. This uses a lightweight calendar picker (Flatpickr). Your backend should: (1) validate availability, (2) reserve the slot, (3) email/SMS reminders, and (4) optionally attach a calendar invite (ICS).
Timezone is required.
Please select a date & time.
We will confirm availability on submit.
(Email/SMS reminders require backend integration using the captured email/phone.)

Review & submit

Confirm your details before submitting your intake.

Final step
Your information
Loading summary...
Consent
Consent is required.
Consent is required.
Treatment (including prescriptions) is decided by the provider based on clinical appropriateness.
Your progress saves automatically as you type.

Complete payment to proceed

We'll begin processing your appointment immediately after payment.

Secure checkout
Order summary
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Payment
This is a placeholder. Redirect to your real payment/checkout route (PayTrace/Stripe/etc.).
Go to Checkout
After payment, show confirmation + next steps (provider review timeline, appointment link, reminders).
Note: you can also embed your hosted payment fields directly on this screen.