Appointment Request

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JourneyLite Appointment Request

Thanks for your interest in JourneyLite, your trusted partner for medical and surgical weight loss! This form will collect the information we need in order to schedule an appointment for the program of your interest. After completing and submitting the form, you will receive a callback from one of our patient service representatives who can answer any questions you may have. There are no financial (or any other) obligations from submitting the form!


Which procedure(s) have you had in the past?
We do not offer surgical revisions for this procedure due to increased risk and poor long-term results. Medication treatment options are available, however. Please change "Appointment Interest" above to "Medical Weight Loss" if you are interested in proceeding!
Your Name*
Your Email*
MM slash DD slash YYYY

At some point we may need to text you appointment reminders or other important information. By providing your phone number, you agree to receive text messages from JourneyLite. Message & data rates may apply. Message frequency varies, we try to keep it to a minimum. Reply STOP to any message to opt out, reply HELP for help. Click here for our Terms & Conditions or our Privacy Policy.

Permission to Text/SMS
Your Address
(for example for 5' 2", enter 5)
(for example for 5' 2", enter 2)
Please note that we require a live, in-person initial consultation to start weight loss medications. In most cases, after the initial appointment, you can do virtual appointments, however every third appointment must be live.
Your BMI is too low for initiation of treatment with weight loss medications. Ohio requires a BMI over 27.
Your BMI is too low for initiation of treatment with weight loss medications. Kentucky requires a BMI over 25, and Ohio requires a BMI over 27.
Are you currently being treated for any of the following issues?*
Your BMI is too low for initiation of treatment with weight loss medications. Ohio requires a BMI over 30, or a BMI of 27-30 with weight-related medical conditions.
Your BMI is too low for initiation of treatment with weight loss medications. Kentucky requires a BMI over 27, or a BMI of 25-27 with weight-related medical conditions.
Have you had any of these issues in the past?*
Do you currently take any of the listed medications below?*
Weight loss medication interest(s):*
Do you currently take any INJECTABLE medications for diabetes?*
Please note that diabetics who already take injectables are not candidates in our program for GLP-1 RA's such as Wegovy (semaglutide) or Mounjaro.
Have you received a prescription for an appetite suppressant from any provider within the last 3 months?*
We require a minimum medication-free break of 3 months before re-starting treatment.
Have you seen us for medical weight loss in the last 12 months?*
Are you currently pregnant or nursing?*
Patients who are pregnancy or nursing are not candidates for weight loss medications.
Do you have a history of drug abuse or addiction?*
Please note that a state-required controlled substance report will be reviewed prior to prescribing any medications. Any false or misleading statements regarding medical conditions, substance abuse history, or recent prescriptions for weight loss medications could result in a permanent ban based on Ohio and Kentucky regulations.
According to the State Medical Boards of Ohio and Kentucky, patients with a current (or past) history of any type of substance abuse disorder are not eligible for weight loss medications.
You may not be eligible for weight loss medications based on your medical history. Your information will be reviewed and a team member will be in contact with you.
You may not be eligible for weight loss medications based on your current medications. Your information will be reviewed and a team member will be in contact with you.
Select Procedures of Interest
Select Procedures of Interest
Select GERD Treatment Interest(s)
Combined Interests
MM slash DD slash YYYY
If you are going through insurance, select your company from the list. If you are unsure about your coverage, select "Unsure." If you know you're insurance doesn't cover surgery, select "Self-pay."

Currently we are not accepting this plan, please check back in the future! If you are a self-pay patient, please proceed.

Pulmonary History*
Check any issues that you currently have, or have had in the past.

Cardiac History-Check all that apply!*
Check any issues that you currently have, or have had in the past.

Gastrointestinal History*
Check any issues that you currently have, or have had in the past.

How did you first hear about us?
By clicking the "Submit Your Appointment Request" button, you give permission for this information to be transmitted via internet to JourneyLite Surgery Center and JourneyLite Physicians.
This field is for validation purposes and should be left unchanged.