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FUNCTIONAL WEIGHT LOSS INTAKE FORM If you are a new patient, please complete all fields. If you are an existing patient, please complete your name and DOB only and skip to Section 2. SECTION 1 Name:.

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Completing the Fwlpaperwork Com online is a straightforward process that allows users to provide essential information efficiently. This guide will walk you through each section and field of the form, ensuring you understand what is required at every step.

Follow the steps to fill out the form accurately and efficiently.

  1. Click ‘Get Form’ button to obtain the form and open it in an online editor.
  2. Start by filling out Section 1, which is required for new patients. Complete the fields for your name, date of birth (DOB), today's date, address, city/state/zip, best contact phone number, email address, and the name of the person who referred you to the office.
  3. In Section 2, provide ratings on a scale of 1-10 for your overall health, diet, and motivation to improve. Include any specific actions you believe are necessary to reach a rating of 10 for each aspect.
  4. Proceed to Section 3, where you must list all current prescription and over-the-counter medications, as well as any supplements or vitamins you regularly take. Check the appropriate boxes regarding your medical history, including high blood pressure, diabetes, and any past surgeries or autoimmune issues.
  5. In Section 4, fill in your current weight, height, and desired weight. Indicate how often you eat out and list frequented restaurants. Also, specify how often you eat at fast food restaurants, and disclose any food allergies you may have.
  6. Review the HIPAA Privacy Practices acknowledgment, then print your name, sign, and provide the date. If applicable, include your parent or guardian's signature for minor consent.
  7. Finally, ensure all sections are complete, and save changes. You may choose to download, print, or share the completed form as needed.

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(Saxenda) Orlistat (, Alli) - () Semaglutide (Wegovy)

is one of the most commonly prescribed medications for weight loss, probably because of its low cost. Data suggests that it can help people shed about 3% to 5% of their initial body weight.

The price depends on the services provided here. On average, an in-person patient pays anywhere from $99-$109, including oral medication and the office visit.

It's associated with weight loss in some research, but it's not FDA-approved for this purpose specifically. The full list of medications you could be prescribed includes: Generics , , , , . GLP-1s Ozempic, Mounjaro, Wegovy, Trulicity, Rybelsus, Saxenda, .

Weight Loss Injections at Figure Weight Loss They help manage hunger and calorie processing. Some common names for these injections include Wegovy, Saxenda, Mounjaro, Semaglutide, and Ozempic.

How much does the program cost? The price depends on the services provided here. On average, an in-person patient pays anywhere from $99-$109, including oral medication and the office visit.

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