Medical Weight Loss Questionnaire "*" indicates required fields Do you or anyone in your family have a history of thyroid cancer?*YesNoUnsureWhat is your current BMI?* Please use this link to calculate your BMI: https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm – If your BMI is less than 27 you do not meet criteria for this treatment. However, we do offer another option for weight loss that may work for you. Please reach out to us for more information. Do you have any history of multiple endocrine neoplasia type 2?*YesNoDo you have any kidney impairment, kidney disease, kidney failure renal cancer or pancreatitis?*YesNoDo you have a primary care physician?*YesNoHave you seen the primary care and had basic lab work drawn within the past year?*YesNoPhoneThis field is for validation purposes and should be left unchanged.
