At Momentum Health 360, your safety comes first. Kindly complete this Glutathione assessment so our specialists can evaluate your profile and recommend the most suitable approach.
Sex at Birth
Privacy Policy | Terms of Service
Let's calculate your BMI
Feet (Height)
Inches
Weight lbs.
BMI (Body Mass Index)
The traditional use of weight loss medications is for individuals with a BMI of 30 and above or to those who are overweight who have associated health conditions. Using it for someone with a BMI range (27-29) without an accompanying health condition is termed "off-label." Using a medication "off-label" refers to the practice of prescribing a drug for a purpose, age group, dosage, or form of administration that is not included in the approved labeling by regulatory agencies like the U.S. Food and Drug Administration (FDA). While a medication undergoes rigorous testing for specific uses before receiving approval, healthcare providers may discover through clinical experience or research that it can be effective for treating other conditions. There may be benefits such as weight reduction for individuals within your range. If you agree to this off-label use, it's crucial to follow the prescribed regimen and report any concerns. Please discuss any questions with us.
Do you have any medical conditions you would like to tell the doctor about?
Have you been diagnosed with any of the following conditions?
Do you use any supplements?
Do you have any allergies?
Are you currently pregnant, breastfeeding, or planning on becoming pregnant?
What is your primary reason for requesting the medication?
How would you describe your sleep quality?
How would you describe your stress level?
How physically active are you?
Are you experiencing any of the following?
Read the following for more informationabout this product and its potential side effects.
The FDA says that these medications may pose a risk to the developing fetus (baby) if you get pregnant while taking it. Oral contraception is not enough because this medication caninterfere with its effectiveness. For birth control you must use condoms, an IUD, or an implanted device. The FDA officially recommends that for the first month after starting a weight lossmedication, and for the first month after each dose escalation,continue using your oral contraception and add a barrier method of contraception (such as condoms) to prevent pregnancy.
Alternatively, you can switch to a non-oral contraceptive method (such as an IUD or implant) before starting your medication. When you stop the medication, you must continue using a backup method (like condoms) for two months after stopping to allow the medication to fully leave your system before getting pregnant. Similarly, it is not known to be safe in breastfeeding. If you are breastfeeding, consult your doctor for safe weight loss options.
Do you take any of the following medications?
● Insulin
● Glimepiride (Amaryl)
● Glipizide (Glucotrol and Glucotrol XL)
● Glyburide (Micronase, Glynase, and Diabeta)
● Sitagliptin
● Saxagliptin
● Linagliptin
● Alogliptin
Truthfulness Consent
Please attest to the following confirming that all information you have provided to us is true and complete.
Consent: I verify that I am the patient and that I have answered the questions asked in this intake form. I confirm that I have reviewed and understood all the questions asked of me. I attest that the answers and information I have provided in this questionnaire is true and complete to the best of my knowledge. I understand that it is critical to my health to share complete health information with my doctor. I will not hold the doctor or affiliated medical practice responsible for any oversights or omissions, whether intentional or not, in the information that I provided.
