GLP-1 program — built just for you

It’s not magic – it’s the power of metabolic science. GLP-1 medications replicate natural hormones that control appetite and blood sugar, helping to enhance metabolism and curb cravings.

We know that successful weight loss isn’t about willpower – it’s about consistency. With a simple, once-weekly GLP-1 treatment designed just for you, you could lose up to 20% of your body weight.

Personalized weight loss plans from licensed experts.

GLP-1 Eligibility Quiz

What is your age?*

Are you currently taking any GLP-1 medications?*

Yes

No

Are you currently pregnant, breastfeeding, or planning to become pregnant within the next 2 months?*

Yes

No

Your medical history

Share your current medications, past surgeries, and any known allergies so your doctor has the full picture.

Are you currently taking any medications?*

Including prescription, over-the-counter (OTC), and supplements

Yes

No

Add your medications*

Any surgeries you have had in the past:*

Yes

No

Please list all of your surgeries*

Any allergies you have had in the past:*

Yes

No

Please list all of your known allergies:*

Do you currently have any of the following medical conditions:*

Gastroparesis
Pancreatic Cancer
Pancreatitis
Type 1 Diabetes or Diabetes Requiring Insulin
Hypoglycemia
Medullary Thyroid Cancer (MTC) or family history of MTC
Bipolar Disorder
Schizophrenia
Multiple Endocrine Neoplasia syndrome type 2 (MEN-2) or family history of MEN-2
Anorexia or Bulimia
Current Symptomatic Gallstones or Active Gallbladder Disease
Active Substance Abuse Disorder

Yes

No

Please list the condition(s) you currently have*

Personal Information

Confirm that everything you’ve shared is accurate before submitting your form.

This field is hidden when viewing the form

Please upload a government-issued form of ID*

Passport, etc. — ensure your full name and photo are easily visible.

Accepted file types: jpg, gif, png, pdf, Max. file size: 128 MB.

Name*

Shipping Address*

Email*

Phone*

DOB*

Please attest to the following confirming that all information you have provided to us is true and complete. If you do not agree, you may not submit this form.*

I confirm that I am the patient completing this intake form and have reviewed all questions carefully. I attest that my answers are true, accurate, and complete to the best of my knowledge. I understand the importance of providing my doctor with complete and accurate health information for my care.

I agree and consent

I do not agree

Payment Information

Card Detail

Complete Checkout to Submit Your GLP-1 Request

Your intake is not submitted until your payment information is entered and you click “Submit Intake & Complete Checkout”.

Enter your card to submit your request for provider review. Your GLP-1 plan cannot be reviewed, approved, or shipped until checkout is complete.

Medication: Personalized GLP-1 Medication

Delivery Plan: Monthly Plan

Shipping: FREE

Monthly Price: $254/mo

Total : $254

Today’s checkout amount is $254. If a provider recommends a different medication, dose, or pharmacy option that changes your price, we will contact you before any change is processed.

Only 22 Discounts left. Yours is reserved for minutes.

Prescribed & shipped within 48 hours.

Unlimited Doctor calls 7 days a week.

Promo Code

Yes

I agree to the CareValidate Inc. Terms and Conditions , Privacy Policy , Refund Policy , and that my card will be held on file. I agree that a $254 charge billed as will appear on my card statement at the time of service. Today’s checkout amount is $254. If a provider recommends a different medication, dose, or pharmacy option that changes your price, we will contact you before any change is processed.