Semaglutide questionaire

BYOP, Save $50

Save $50 on each order by bringing your own brand name prescription from your doctor. Simply provide us with your doctor's information. We'll take take if from there!

Bring My Prescription

Get New Prescription

Whether you already have a prescription and want to save $50 every month or if you need one from our doctors to get started immediately, we've got you covered!

If you already have a Brand Name prescription, simply select 'Bring Prescription' and provide us with your doctor's information, and we'll take care of the rest by sending over the compounded Semaglutide prescription to your doctor for their approval. Alternatively, if you prefer our full-service option, our most popular option, our doctors can process your prescription today. Simply select 'Get Prescription' above.

Existing Prescription

Save $50 on each order when you bring your own prescription from your doctor. If you'd like, please provide us with your prescription information we'll handle the rest.

Doctor Name

Please specify an answer

Prescription Name?

Please specify an answer

Prescription Dosage?

Please specify an answer

Date of Birth

Please specify an answer

I agree to authorize US Health and Wellness (dba Semaglutide Online), medical affiliates and only U.S.-certified compounding pharmacies to access my physician’s contact details and prescription history for the transfer and or approval of my Semaglutide prescription. In light of recent drug shortages, as overseen by the FDA, this prescription may be compounded using FDA-approved ingredients to ensure continuity of care. I understand that the FDA monitors drug shortages and permits compounding pharmacies to produce drugs under specific conditions during these shortages to meet patient needs. I consent to all necessary communication with my doctor and affiliates and acknowledge the importance of this step in the process. With this, I agree to proceed.

Nearly done

What's the best way for the Doctor to reach you if they have additional questions?

Please continue only if you're genuinely interested in treatment and will be available for communication with our healthcare team

First name

Please enter your first name

Last name

Please enter your last name

Email address

Please enter a valid email address

Please respect and value the time of our healthcare team and only request your free patient evaluation if you are seriously considering treatment and are willing to communicate with our healthcare team for setup via text message or phone. Our plans feature 30 days with no initial payment and affordable monthly options to accommodate most budgets, all part of our high-quality online healthcare services.

Includes up to 2 months free with purchase.

I agree with the terms and conditions of US Health and Wellness - www.rx.life Free Patient Rx Evaluation. I consent to and request to be contacted via the provided channels: press-to-be-transferred auto-call, text message www.Rx.Life, email, and phone call. Data rates may apply. I understand that I can opt-out at any time by emailing info@rx.life info or calling 888-503-1918

I agree with the terms and condition of US Health and Wellness - semaglutide-online.com's Free Patient Rx Evaluation. I consent to and request to be contacted via the provided channels: press-to-be-transferred auto-call, text message, email, and phone call. Data rates may apply. I understand that I can opt-out at any time by emailing info@semaglutide-online.com or calling 877-999-2466

Nearly done!

What's the best way for the Doctor to reach you if they have additional questions?

First name

Please enter your first name

Last name

Please enter your last name

Email address

Please enter a valid email address

Phone number

Please enter a valid phone number

I agree with the terms and conditions of Semagtlutide-onlne.com I am agreeing to be contacted via the provided channels. Text message , call, and data rates may apply. I understand that I can opt out anytime by emailing info@ushwn.com

Suitability Results ⛔

Based on your pre-screening answers, it has been determined that the Semaglutide weight loss program may not be the best fit for you. However, we encourage you to explore alternative weight loss options below, as our providers offer a range of programs that may better suit your needs.

Semaglutide Eval

Refund initiated

Refund on its way

Refund complete

We regret to inform you that your request for the Semaglutide weight loss program has not been approved. This decision is based on the information provided in your pre-screening questionnaire. If you have made a payment for the request, we want to assure you that a refund will be processed within 3-5 business days

Now what?

Explore other great options below

Want to discuss other options?

If you would like to explore other options or discuss alternative treatments, please let us know by clicking the option below, and one of our doctors' offices will contact you to provide further guidance.

Call me to discuss

Email me options

Best option: 6-month package ✅

Based on your pre-screening answers

Health Quiz : Complete

Approved

Select package

Activate Free Month

6 Month Package

Semaglutide Injections

$83 per month when financed at 0% (24mo.) $1999 Total

Plus get 1 FREE bonus month*

3 Months Semaglutide Injections ( Any Dose )

$899 or $42 per month with 0% Financing(24mo.)

New patients get 2 FREE bonus weeks *

1 Month Semaglutide Injections ( Any Dose )

$299/month

New patients get 2 FREE bonus weeks*

Did you know?

You can schedule a free telehealth consultation right now. Click here to book a call with our patient success team, we'll give you a call and be happy to answer all of your questions on your time.

Questions? No hold times

Get answers, connected in 60 seconds or less. We encourage you to call or text us at 888-503-8488 for info on demand.

Receive real answers to your questions without the hassle of phone trees or transfers; you won't be bounced around just to get a simple answer. That's right, you can text or call us anytime. We're using some of the most cutting-edge technologies in the world to simplify our patient experience. With just one phone number and one text number, 888-503-8488, get your questions answered.

We utilize automation and AI whenever it can make your interaction smoother. However, rest assured, we'll always maintain that personal, human touch whenever possible to ensure your patient experience is truly exceptional.

Guaranteed Coverage for All Doses:

Receive prescribed dose without extra costs( Max dose 2.4 mg once weekly).

No physical exam

100% online

Transparent, All Inclusive Pricing:

Our clear pricing model means no surprises and no hidden fees.

Max Dose Coverage:

Receive prescribed dose without extra costs( Max dose 2.4 mg once weekly).

HIPPA Compliant

Your data is protected

Trusted Care, Compliant Practices

Our pharmacy partners strictly adhere to all current regulatory standards and maintains full compliance with state and federal pharmacy laws to ensure the highest level of safety and quality in our services and products.

Proud to be LegitScript Certified

Please respect and value the time of our healthcare team and only request your free patient evaluation if you are seriously considering treatment and are willing to communicate with our healthcare team for setup via text message or phone. Our plans feature 30 days with no initial payment and affordable monthly options to accommodate most budgets, all part of our high-quality online healthcare services.

Includes up to 2 months free with purchase.

Visit LegitScript to Learn More

REQUIRED

Semaglutide Medical Questionnaire

Take just 2 minutes to answer a few important questions that will assist your physician in determining if a Prescription Semaglutide for weight loss is suitable for you.

Please confirm your date of birth

Your healthcare provider will need to know your date of birth to help determine the appropriate medications for you.

Minimum Age Requirement of 18 Years or Older

What's your height and weight?

What is your gender?

Are you pregnant?

What is the first and last day of your most recent menstrual cycle?

Do you use tobacco?

Do you have a history of cancer?

Have your mother, father, or biological siblings had cancer?

Have you been diagnosed with multiple endocrine neoplasia type 2

Do you or your family members have a history of medullary thyroid carcinoma?

Do you have diabetic ketoacidosis?

Do you have a history of pancreatitis?

Do you have any known allergies or hypersensitivities to medications, vitamins, or supplements?

Allergies and Hypersensitivities

To help your physician assess your suitability for Semaglutide RX, please let your physician know of any allergies or hypersensitivities

Are you taking any vitamins, or supplements?

Vitamins, and Supplements

To ensure your physician can accurately determine if Semaglutide is right for you, please inform them of all vitamins and supplements you currently take.

Have you been prescribed any of these medications?

Please select 'Yes' if you currently have a prescription, are using, or have previously used Semaglutide or any other GLP-1 receptor agonists.

BYOP, Save $50

Save $50 on each order by bringing your own brand name prescription from your doctor. Simply provide us with your doctor's information. We'll take take if from there!

Existing Prescription

Save $50 on each order when you bring your own prescription from your doctor. If you'd like, please provide us with your prescription information we'll handle the rest.

Almost Finished!

Are you currently under the care of a physician for any other medical conditions?

Additional Medical History

We're analyzing your results right now…

Please wait briefly as we determine if Semaglutide could be a suitable weight-loss solution

We're analyzing your results right now…

Please wait briefly as we determine if Semaglutide could be a suitable weight-loss solution

What's the best way for the Doctor to reach you if they have additional questions?

Please continue only if you're genuinely interested in treatment and will be available for communication with our healthcare team

Includes up to 2 months free with purchase.

What's the best way for the Doctor to reach you if they have additional questions?

We're analyzing your results right now…

Please wait briefly as we determine if Semaglutide could be a suitable weight-loss solution

Resluts : APPROVED ✅

Suitability Results ⛔

Now what?

Explore other great options below

Want to discuss other options?

If you would like to explore other options or discuss alternative treatments, please let us know by clicking the option below, and one of our doctors' offices will contact you to provide further guidance.

Best option: 6-month package ✅

6 Month Package

Semaglutide Injections

$83 per month when financed at 0% (24mo.) $1999 Total

Plus get 1 FREE bonus month*

$899 or $42 per month with 0% Financing(24mo.)

New patients get 2 FREE bonus weeks *

$299/month

New patients get 2 FREE bonus weeks*

Includes up to 2 months free with purchase.

Call or text our friendly patient care team

1-888-503-8848

Want us to call you?

Thanks, @first-name-pending! 👍

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