Get Started | InstantMed

Weight loss assessment

Step 1 of 4

~5 min left

Current weight (kg)*

Height (cm)*

Target weight (kg)*

What have you tried before?*

No previous attemptsDiet and exercise onlyWeight loss programs (e.g., Weight Watchers)Weight loss medicationMultiple methods

Relevant medical history

Toggle on any conditions that apply to you.

Type 2 diabetes

Heart condition or cardiovascular disease

High blood pressure

Thyroid disorder

Sleep apnea

PCOS (polycystic ovary syndrome)

Are you currently pregnant, possibly pregnant, or breastfeeding?*

YesNo

Have you, or anyone in your family, had medullary thyroid cancer or MEN2 syndrome?*

YesNo

Have you ever had pancreatitis?*

YesNo

Have you ever been diagnosed with or treated for an eating disorder?*

YesNo

Have you had any adverse reactions to weight loss medications?*

YesNo

What are your weight loss goals?*

0/20 characters minimum

Loading this step

Preparing your form

Current weight (kg)*

Height (cm)*

Target weight (kg)*

What have you tried before?*

No previous attemptsDiet and exercise onlyWeight loss programs (e.g., Weight Watchers)Weight loss medicationMultiple methods

Relevant medical history

Toggle on any conditions that apply to you.

Type 2 diabetes

Heart condition or cardiovascular disease

High blood pressure

Thyroid disorder

Sleep apnea

PCOS (polycystic ovary syndrome)

Are you currently pregnant, possibly pregnant, or breastfeeding?*

YesNo

Have you, or anyone in your family, had medullary thyroid cancer or MEN2 syndrome?*

YesNo

Have you ever had pancreatitis?*

YesNo

Have you ever been diagnosed with or treated for an eating disorder?*

YesNo

Have you had any adverse reactions to weight loss medications?*

YesNo

What are your weight loss goals?*

0/20 characters minimum