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Weight Loss by Curewell In-Take Form

Prescreening Questionnaire 

Why are you looking to lose weight?
Are you currently on or have you previously been prescribed semaglutide?
Are you allergic to Motrin?
Are you allergic to Aspirin?
Are you on any blood thinners (Warfarin, Xarelto, Etc)?
Do you have high blood pressure / hyper tension?
Are you diabetic?
Do you have a heart arrhythmia?
Any history of Thyroid caner?

I confirm, that by submitting the above information I am certifying the information is correct to the best of my knowledge.

Thanks for submitting! Feel free to book your consultation online, or wait for a member of our team to reach out to you!

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