Do you already have a treatment in mind? *Treatment Preference

What have you tried for weight loss in the past? *

Diet or nutrition changes

Exercise or fitness programs

Commercial weight-loss programs

Prescription weight-loss medications

Over-the-counter medications or supplements

Working with a doctor or other clinician

I haven’t really tried anything yet

Previous Weight Loss Attempts

What’s been the most frustrating part of trying to manage your weight? *

Losing weight and gaining it back

Feeling hungry or fighting cravings

Not seeing results despite trying

Finding an approach I can actually stick with

Side effects or problems with previous medications

Not knowing which treatment is right for me

Getting enough support or medical guidance

I’m just getting started

Weight Loss Frustrations

Let’s save your progress

We’ll use your information to save your answers and provide your next steps. If this screening allows you to proceed, you can book a no-charge video visit.

A doctor needs to verify information with you based on your answers. Eligibility and treatment are subject to physician evaluation.

No payment is required to book this visit, and there is no obligation to enroll.

First Name *

First Name

Last Name *

Last Name

Email *

Phone *

phone

Want us to text you about important updates, like appointment reminders and next steps after your screening? No marketing texts.

By checking this box, I consent to receive non-marketing text messages from Simply Metabolic Physicians P.C. about my screening, enrollment next steps, and appointment reminders. Message frequency varies. Message and data rates may apply. Text HELP for assistance or reply STOP to opt out. Consent is not a condition of purchase.

Almost there. Just a few quick questions to make sure we’re able to see you. *

This screening is for eligibility purposes only and does not establish a physician-patient relationship or constitute personalized medical advice. By continuing, you accept these terms. Consult your own physician for medical advice.

Current Age: (in years) *

Current age

Height — feet *

Height — inches *

Weight (in Pounds) *

Do you principally reside (live in and spend most of your time) in South Carolina? *

Yes, I live within the state of South Carolina

No, I do not live in the state of South Carolina

Are you currently enrolled in Medicare, Medicaid, or TRICARE? *

Yes, I am currently enrolled in one of these programs.

No, I am NOT enrolled.

I'm not sure.

Have you ever been diagnosed with anorexia nervosa or bulimia nervosa? *

Yes

I'm not sure

Have you been hospitalized for a mental health condition in the past 12 months? *

Yes

I'm not sure

• You or a family member has multiple endocrine neoplasia syndrome type 2 (MEN 2).

• You or any family member has had medullary thyroid cancer (MTC).

• You have been diagnosed with type 1 diabetes (not type 2).

Do any of the above apply to you? *

Yes

I'm not sure

• A history of gastroparesis (stomach paralysis), intestinal obstruction, or pancreatitis.

• Bariatric (weight-loss) surgery in the past 6 months.

• Gallbladder surgery in the past 3 months.

• Active gallbladder problems within the past year without gallbladder surgery.

• End-stage liver cirrhosis with ascites (fluid buildup in the abdomen).

Do any of the above apply to you? *

Yes

I'm not sure

• Insulin, such as insulin glargine (Lantus), insulin lispro (Humalog), or insulin aspart (NovoLog).

• A DPP-4 inhibitor, such as sitagliptin (Januvia), linagliptin (Tradjenta), saxagliptin (Onglyza), or alogliptin (Nesina), including combination pills.

• A sulfonylurea, such as glipizide (Glucotrol), glimepiride (Amaryl), or glyburide (Diabeta), including combination pills.

Are you currently taking any of the medications listed above? *

Yes

I'm not sure

• You have congestive heart failure (CHF) that is currently being treated.

• You take furosemide (Lasix) or bumetanide (Bumex) for fluid retention.

Do either of the above apply to you? *

Yes

I'm not sure

• You have kidney disease.

• You receive dialysis.

• You have had a recent kidney injury.

Do any of the above apply to you? *

Yes

I'm not sure

Have you been diagnosed with diabetic retinopathy or received treatment for diabetes-related eye disease? *

Yes

I'm not sure

Do you have an upcoming surgery or procedure that will involve anesthesia or deep sedation? *

Yes

I'm not sure

Have you ever had an allergic reaction to a GLP-1 medication or any of its ingredients? *

Yes

I'm not sure

Which medication or ingredient caused the reaction, and what happened? *

Are you currently taking a GLP-1 medication? Examples include Zepbound, Mounjaro, Ozempic, Wegovy, Saxenda, Trulicity, Rybelsus, Foundayo, or compounded semaglutide or tirzepatide. *

Yes

I'm not sure

Which GLP-1 medication are you taking? *

When did you last take it?

If you do not remember the date, leave this blank for the doctor to clarify.

What was your last dose? *

Have you had any significant side effects from your current GLP-1 medication? *