care4life healthcare
  • HOME
  • SERVICES AND PRICES
  • MEDICAL QUESTIONNAIRE
  • weight loss FAQs
  • NOTICE PRIVACY PRACTICE
  • ABOUT US
  • TERMS AND POLICY
  • CONTACT US
  • More
    • HOME
    • SERVICES AND PRICES
    • MEDICAL QUESTIONNAIRE
    • weight loss FAQs
    • NOTICE PRIVACY PRACTICE
    • ABOUT US
    • TERMS AND POLICY
    • CONTACT US
care4life healthcare
  • HOME
  • SERVICES AND PRICES
  • MEDICAL QUESTIONNAIRE
  • weight loss FAQs
  • NOTICE PRIVACY PRACTICE
  • ABOUT US
  • TERMS AND POLICY
  • CONTACT US

Transform Your Health Today

Medical Questionnaire

 Critical Medical History
Before starting a semaglutide treatment plan, healthcare providers use targeted screening questions to ensure the medication is safe and appropriate for you. To identify potential "absolute contraindications," you must confirm the following before proceeding with your order: 

 I confirm that I DO NOT HAVE any of the following:

  • Thyroid History: A personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome (MEN).
  • Pancreatic Health: A history of pancreatitis (inflammation of the pancreas).
  • Pregnancy/Nursing: Current pregnancy, breastfeeding, or plans to become pregnant within the next two months.
  • Diabetes Type: A diagnosis of Type 1 diabetes or diabetic ketoacidosis.

Existing Conditions & Risks
I confirm that I DO NOT HAVE a history of:

  • Kidney disease or gallbladder problems.
  • Diabetic retinopathy.
  • Severe stomach issues or gastroparesis (slowed stomach emptying).
  • Depression or suicidal thoughts.

Program Requirements
By proceeding, I also confirm the following:

  • Commitment: I am comfortable with self-administering once-weekly injections.
  • Weight History: My BMI is greater than 25 kg/m².
  • Medications: I am not currently taking insulin or other blood-sugar-lowering medications.




Copyright © 2021 Care4Life Healthcare Services, LLC. - All Rights Reserved.


Powered by

This website uses cookies.

We use cookies to analyze website traffic and optimize your website experience. By accepting our use of cookies, your data will be aggregated with all other user data.

Accept