- CosmeticRX

Weight loss doesn’t just come down to finding the perfect balance of ‘eating right’ and ‘exercising’.

For some, individual factors like genetics and hormones make it more challenging than it should be. CosmeticRx can help.

How much weight are you looking to lose?

< 20 lbs 21-50 lbs 51+ lbs Not sure yet

Your goal is within reach.

Your goal to lose - is within reach.

To find a personalized plan for you, our physicians need you to build your Weight Loss Profile first.

Ready?

What is your biggest barrier to weight loss right now?

Low energy/fatigue Cravings/sleep/stress

Let's start with where you are now

Your height

Feet Inches

Your current weight

Pounds Pounds

Your BMI is 0

Your BMI should be 30 or higher

What do you want to accomplish with the CosmeticRx Body Program

I want to...

Lose weight Improve my general physical health Improve another health condition Increase confidence about my appearance Increase energy for activities I enjoy I have another goal not listed above

Your Weight

0 lbs

Do you currently have, or have you ever been diagnosed with, any of the following heart or heart-related conditions?

Select all that apply.

Atrial fibrillation or flutter Tachycardia (episodes of rapid heart rate) Heart failure Heart disease, stroke, or peripheral vascular disease Prolonged QT interval Other heart rhythm issues or ECG abnormalities Hypertension (high blood pressure) Hyperlipidemia (high cholesterol) Hypertriglyceridemia (high triglycerides) No, I have not been diagnosed with any of these heart conditions

Do you currently have, or have you ever been diagnosed with, any of these hormone, kidney, or liver conditions?

Select all that apply.

Multiple Endocrine Neoplasia syndrome type 2 (MEN2) Personal history of thyroid cancer Family history of thyroid cancer Chronic kidney disease Diabetes requiring insulin Type 2 Diabetes Prediabetes and Insulin Resistance Fatty liver disease (NAFLD or NASH) Kidney stones Liver cirrhosis or end stage liver disease Hypothyroidism (low functioning thyroid) Hyperthyroidism (high functioning thyroid) Graves disease Other thyroid issues Syndrome of Inappropriate Antidiuretic Hormone (SIADH) No, I have not been diagnosed with any of these conditions

Do you currently have, or have history of, any of these gastrointestinal conditions or procedures?

Select all that apply.

Bariatric surgery Pancreatitis History of delayed gastric emptying or gastroparesis Gallstones or other gallbladder issues GERD / Acid Reflux No, I have not been diagnosed with any of these conditions or procedures

Do you currently have, or have you ever been diagnosed with, any of these additional following conditions?

Select all that apply.

Chronic candidiasis (fungal infection) Eating disorder Gout Lymphedema or chronic lower extremity swelling where other causes have been ruled out Metabolic syndrome Obstructive sleep apnea Osteoarthritis Tinea infections (skin folds) No, I have not been diagnosed with any of these conditions or procedures

Do you have an ALLERGY to GLP-1 agonist medications?

Examples include tirzepatide (Zepbound/Mounjaro), liraglutide (Saxenda/Victoza), semaglutide (Wegovy/Ozempic), and dulaglutide (Trulicity)

No, I do not have an allergy to GLP-1 medication Unfortunately, I am allergic to GLP-1 medication

Please provide your contact number

Are you currently taking a GLP-1 medication in the past 30 days?

No, I am not currently taking a GLP-1 medication in the past 30 days. Yes, I am currently taking a GLP-1 medication in the past 30 days.

Please select the GLP-1 medication and the weekly strength in mg (milligrams). If you provide units this is not acceptable — our team needs to know how many mg weekly of a dose.

Do you currently take any of the following medications?

Select all that apply.

Sulfonylureas such as (but not limited to) glipizide (Glucotrol), glimepiride (Amaryl) Insulin Warfarin (also called Jantoven or Coumadin) - a blood thinner that usually requires regular lab testing Meglitinides such as repaglinide or nateglinide Diuertics such as (but not limited to) furosemide (Lasix), bumetanide (Bumex) Hydrochlorothiazide/HCTZ Selective Seroonin Reuptake Inhibitors (SSRIs) such as (but not limited to) citalopram (Celexa), fluoxetine (Prozac), escitalopram (Lexapro) Monoamine Oxidase Inhibitors (MAOIs) such as (but not limited to) phenelzine (Nardil), selegiline (Emsam) None of the above

List any medications that you take.

Is there anything else you want your healthcare provider to know about your health?

Include any additional details about the conditions you've already reported.

No Yes

You've qualified for treatment

Lose lbs in a year

Are you a new or existing user to CosmeticRx

I am a new user I am an existing user

Choose your GLP-1 medication

How much weight are you looking to lose?

What is your biggest barrier to weight loss right now?

Let's start with where you are now

What do you want to accomplish with the CosmeticRx Body Program

Do you currently have, or have you ever been diagnosed with, any of the following heart or heart-related conditions?

Do you currently have, or have you ever been diagnosed with, any of these hormone, kidney, or liver conditions?

Do you currently have, or have history of, any of these gastrointestinal conditions or procedures?

Do you currently have, or have you ever been diagnosed with, any of these additional following conditions?

Do you have an ALLERGY to GLP-1 agonist medications?

Are you currently taking a GLP-1 medication in the past 30 days?

Please select the GLP-1 medication and the weekly strength in mg (milligrams). If you provide units this is not acceptable — our team needs to know how many mg weekly of a dose.

Do you currently take any of the following medications?

List any medications that you take.

Is there anything else you want your healthcare provider to know about your health?

You've qualified for treatment

Cookies