Advantage Weight Loss

Are You Currently Taking A GLP-1 Weight Loss Medication?

1

YES

2

NO

We ONLY Prescribe from Accredited LegitScript Certified Compounding Pharmacies. With the Highest Standards in Purity and Potency

Are You Currently Taking A GLP-1 Weight Loss Medication?

If Yes, Which GLP-1 Medication?

1

Semaglutide

2

Tirzepatide

3

Monjaro

4

Ozempic

Do any (1 or more) of these conditions apply to you ?

(Most Common Answer)

1

Have you ever been diagnosed with Type 1 or Type 2 Diabetes?

2

Do you have a history of pancreatitis?

3

Do you have a personal or family history of medullary thyroid carcinoma or MEN 2 (Multiple Endocrine Neoplasia syndrome type 2)?

4

Have you ever experienced gallbladder disease, including gallstones?

5

History of medullary thyroid cancer (MTC)

6

Do you currently have gastrointestinal issues (e.g., gastroparesis, severe GERD, or IBS)?

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Which State Do You Live?

State

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Calculate Your BMI

Feet

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Inches

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Current Weight

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Target Weight

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I'de be Satisfied If I reached my target weight goal in..

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Sync TeleMed Approval

Average Perscription Delivery 39 Hours

You've been sent an A-Sync Intake Form Completing your A-Sync intake will allow our provider to approve you script and have your perscription sent instantly

Any major health issues in your immediate family (parents/siblings)?

1

Diabetes

2

High blood pressure?

3

Heart disease

4

Cancer

5

Stroke

6

None of the Above

Check all that apply in the

Past 2 Weeks:

1

Fatigue

2

Weight gain

3

Weight loss

4

Fever/chills

5

None of the Above

Check all that apply in the

Past 2 Weeks:

1

Chest pain

2

Palpitations

3

Swelling in legs

4

Shortness of breath

5

Cough

6

None of the Above

Check all that apply in the

Past 2 Weeks:

95% Complete

Check all that apply in the

Past 2 Weeks:

A-Sync TeleMed Approval Average Perscription Delivery 39 Hours

*Sync Required in certain states. Please complete and you'll be directed to schedule with our doctor (you may opt into scheduling with our doctors at any time)

Any Past Surgeries

1

Yes

2

No

3

Any Medication Allergies?

Any Past Surgeries

1

Yes

2

No

3

A-Sync TeleMed Approval Average Perscription Delivery 39 Hours

*Sync Required in certain states. Please complete and you'll be directed to schedule with our doctor (you may opt into scheduling with our doctors at any time)

Do you smoke? If yes, how much?

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Do you drink alcohol? If yes, how many drinks per week?

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Do you use recreational drugs? If yes, what type and how often?

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Occupation? Is this occupation physical stressful

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List any prescription, OTC, or supplements you take regularly.

*Sync Required in certain states. Please complete and you'll be directed to schedule with our doctor (you may opt into scheduling with our doctors at any time)

List any prescription, OTC, or supplements you take regularly.

Please specify an answer

Upload a Picture of Your ID

*Verify Idenity with the Pharmacy

Upload a recent full body photo

*Additional verification required by law

Drop your file here or click

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Drop your file here or click

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This asynchronous review will confirm your eligibility and prescription details. Upon Doctor's approval, your prescription will be processed and sent within 24 hours. Please note that approval is subject to the Doctor’s discretion and is applicable only to prescriptions in eligible states.

Not Required for A-Sync Approval *Some states do (we will contact you if Sync is required

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TeleMed Approval

*Please ensure you're prepared with to finalize your enrollment.

TeleMed Approval

*Please ensure you're prepared with to finalize your enrollment.

TeleMed Approval

*Please ensure you're prepared with to finalize your enrollment.

Are You Currently Taking A GLP-1 Weight Loss Medication?

Are You Currently Taking A GLP-1 Weight Loss Medication?

Which State Do You Live?

Lets See if You Qualify

Calculate Your BMI

I'de be Satisfied If I reached my target weight goal in..

Lets See if You Qualify

Unbeatable Prices Direct From our Pharmacy Partners

Save with 3 Month Pricing

Average Perscription Delivery 39 Hours

You've been sent an A-Sync Intake Form Completing your A-Sync intake will allow our provider to approve you script and have your perscription sent instantly

Any major health issues in your immediate family (parents/siblings)?

Check all that apply in the

Past 2 Weeks:

Check all that apply in the

Past 2 Weeks:

Check all that apply in the

Past 2 Weeks:

95% Complete

Check all that apply in the

Past 2 Weeks:

A-Sync TeleMed Approval Average Perscription Delivery 39 Hours

Any Medication Allergies?

A-Sync TeleMed Approval Average Perscription Delivery 39 Hours

List any prescription, OTC, or supplements you take regularly.

TeleMed Approval

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