GLP-1
Have you used ReEnvision in the past?
We’ll begin your health assessment in a moment. But first, a little housekeeping. 🧹
I acknowledge that I have read, understood, and agree to the Telehealth Informed Consent and Notice of Privacy Practices
To route you to a provider in your state, we need to know your location.
What sex were you assigned at birth?
Got it. And what is your gender identity? We ask everyone this question in order to provide you with the best care possible.
Okay, let’s begin your health assessment.
Is this your first time doing a consultation for prescription weight loss medication with ReEnvision?
First, are you already taking a GLP-1 prescription weight loss medication at this time, or have you been on one in the past? This includes (but is not limited to):
Next, please select any/all of the following conditions you’ve been diagnosed with.
Do you have a history of severe hypoglycemia (a drop in glucose levels) that has required treatment by a medical professional?
Do you have a history of any eating disorders, such as anorexia or bulimia?
Do you have any history of pancreatitis or gall bladder disorder?
Have you had any of the following weight loss or digestive tract surgeries?
Do you have a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2?
Do you have a history of any of the following? If so, please select all that apply.
Though rare, some reports have linked this medication with an increased risk of diabetic retinopathy, diabetes-related vision loss and other eye conditions, including blindness. Do you acknowledge these risks and agree to consult an ophthalmologist if necessary?
Do you have a history of depression or any other mental health condition?
Do you have a history of suicidal thoughts or behaviors?
Have you ever been diagnosed with or treated for any of the following?
Semaglutide can cause an increase in heart rate. Do you have tachycardia, or has your doctor ever informed you that you have an elevated resting heart rate (RHR)—a rate above 100 beats per minute?
Okay. Now, let’s collect your resting heart rate—the number of times your heart beats per minute when you’re at rest, typically measured after waking up but before getting out of bed. To measure your RHR, find a quiet place. Sit or lie down, and relax for a few minutes. With your index and middle fingers, locate your pulse on your wrist or neck. For 60 seconds, count the number of beats you feel.
Please confirm that you won’t exceed recommended alcohol limits while taking Semaglutide and that if you do, you’ll pause this treatment and contact your primary care doctor to discuss your safest path forward.
Semaglutide increases pancreatitis risk and should not be taken if you are at risk for alcohol abuse. This means more than 4 drinks on any day or more than 14 drinks per week.Do you currently drink alcohol at this quantity?
Are you taking any other medications or herbal products for weight loss? Examples include:
Are you taking any of the following medications?
Are you taking any of the following medications?
Prescription weight loss medications should not be attempted before you have tried to lose weight through lifestyle changes like diet and exercise.
Can you confirm that you’ve actively tried to lose weight by modifying your diet and regularly exercising for at least 6 months straight? You can have done this independently or though a weight loss or fitness program.
Do you have any known drug allergies?

Maximum file size: 15.36MB

Maximum file size: 15.36MB

Got it. Based on your answers, you don’t need to have a video consult we will reach out with a time a date or you can call our offices at: (xxx)xxx-xxxx
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