New Hope Weight Loss · HIPAA Secure

Doctor-Led Medical Intake

A calm, secure intake for your New Hope physician review. Please answer as accurately as you can so the clinical team has the right information before any payment step.

Step 1: Your basic information
These details help the doctor review your history safely and route your next step correctly.
Your information is saved securely before you are offered the doctor-review payment page.
Shipping / Mailing Address
Please complete all required fields and the consent box.
Step 2: Safety screening
Please check all that apply. These answers help the physician determine whether GLP-1 treatment can be considered safely.
If any item applies, we will not send you to payment from this intake. Your safety comes first.
Please make a selection to continue.
Step 3: Additional health history
Please make one or more selections. Choose None if no conditions apply, then add any details the doctor should know before reviewing your intake.
Please make a selection to continue.

Thank you for your honesty.

Based on your answers, we're unable to offer GLP-1 treatment at this time. Please consult your own physician regarding your care.

Your medical intake is complete.

Thank you — your health history has been submitted for review. The next step, if you choose to continue, is the separate doctor review, consultation, and prescription-review fee.

Use code DOCTOR20 on the next page: the $119 doctor-review fee becomes $99. This does not guarantee prescription approval; the doctor determines whether treatment is appropriate.
Your information is kept private and secure.