AM I A semaglutide CANDIDATE?Please fill out the form below and one of our team members will contact you shortly. Thank you! Name * First Name Last Name Email * Do you have any history of pancreatitis? * Yes No Are you currently pregnant or breastfeeding? * Yes No Do you have a personal or family history of medullary thyroid carcinoma or Endocrine Neoplasia Syndrome type 2? * Yes No Do you have any history or current problems with unstable mental health, depression, or eating disorders? * Yes No Do you have a history of kidney or liver concerns? * Yes No Do you think you fit the definition of obesity (BMI >27)? * Phone Number Anything else you'd like us to know? Thank you!
