Medical Weight Loss Appointment Request

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Our maximum age for weight loss medications is 70.

Please enter a number from 4 to 7.
(for example for 5' 2", enter 5)
Please enter a number from 0 to 11.9.
(for example for 5' 2", enter 2)

Please enter a number from 100 to 1000.

First appointment must be in-person!

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?*
Medication Interest(s):*
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 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.

By clicking the "Submit" button I attest that all information is accurate, and I give permission for this information to be transmitted via internet to JourneyLite Physicians. The information will be reviewed as soon as possible and you will be contacted by our team.
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