MultiMedRx - Modern Healthcare Made Easy

Reach your goal weight without restrictive diets and exercise. What is your gender? *

This helps us understand your body complexity and hormones so we can assess you better.

Male

Female

What is your age range? *

18–29 Years

30–44 Years

45–59 Years

60 Years or older

Please select one option above!

What's your height and weight? *

Feet *

Inches *

Weight (lbs) *

Perfect! With a BMI of , we can continue.

We're in this together. Your goal is our goal.

What is your goal weight? *

First Name *

Last Name *

What state will your medication be shipped to? *

Your information is never shared and is protected by HIPAA.

test , how can you be reached if necessary?

Our medical teams and pharmacy use email and text for patient communication.

Email *

Phone Number *

Your information is never shared and is protected by HIPAA.

MultiMedRx is proud to be ranked #1 on c|net

We can help with all of these, but choose the most important for you.

What is your primary health or body goal right now? *

Please select one option!

It feels like magic, but it's metabolic science.

On average, GLP-1 patients lost 18% of their body weight.

GLP-1 medications offer effective active ingredients — but at a fraction of the price (80% less) and are more consistently available.

How will GLP-1 work for you?

Week 1 - 4 : Your body gets acclimated to GLP-1 medication
Week 4 - 8 : Weight loss is increasing more and more
Week 9+ : Your body has become a fat burning machine

We identify the root causes of your metabolic issues, so you get a long-term solution, not just another quick fix.

GLP-1 is safe, but these health conditions might prevent you from being prescribed.

Your answers are completely confidential and protected by HIPAA

Do any of these apply to you? *

How often do you exercise or engage in physical activity? *

Rarely or never (little to no activity)

1–2 days per week (light activity or walking)

3–4 days per week (moderate workouts)

5–6 days per week (consistent exercise routine)

Daily or very active lifestyle

Please select one option above!

Do you smoke? *

Yes

No

Please select one option above!

Do you use recreational drugs? *

Yes

No

Please select one option above!

How would you describe your overall eating habits? *

Very healthy (mostly whole foods, balanced meals)

Somewhat healthy (occasional junk food)

Average (mix of healthy and unhealthy)

Unhealthy (frequent fast food or sugary snacks)

Very unhealthy (mostly processed or fast food)

Please select one option above!

How many meals do you typically eat per day?*

1 meal

2 meals

3 meals

4–5 small meals

Please select one option above!

How often do you eat fast food or junk food? *

Never or rarely (less than once per week)

1–2 times per week

3–4 times per week

Nearly every day

Multiple times per day

Please select one option above!

How many times do you eat out per week, not including fast food.? *

Never or rarely (less than once per week)

1–2 times per week

3–4 times per week

Nearly every day

Please select one option above!

How often do you consume alcohol? *

Never

Occasionally (1–2 drinks per week)

Frequently (3–5 drinks per week)

Daily

Please select one option above!

State your current stress level*

Minimal / None

Mild / Low

Moderate

High / Significant

Severe / Intense

Please select one option above!

What are the primary sources of your stress?*

Job/Career

Personal/Relational

Health-related

Financial

Please select one option above!

What is your preferred medication for your weight loss journey? *

Semaglutide

Tirzepatide + Glucagon Receptor Agonism

Please select one option above!

How about weight loss programs? Are you currently taking a GLP-1 medication? *

Yes, I am currently taking a GLP-1

No, I am not taking a GLP-1

Please select one option above!

Do you have insurance? *

Yes

No

Please select one option above!

What's your date of birth? *

Month *

Day *

Year*

Your Medical Review

BMI: 17.04
Current Weight: 140lbs
Goal Weight: 130lbs within 4.76 weeks

You are a strong candidate for medical weight loss with a 94% chance of successful treatment if qualified.

I understand that my information is never shared, is protected by HIPAA and agree to the terms and privacy policies and to be contacted as necessary by MultiMedRX and its medical partners and can opt-out at any time. *

Your information is never shared and is protected by HIPAA.

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