Questionnaire | NewBody Rx

Let's start with the basics

Your height

Your current weight

Your date of birth

Your age

Your calculated BMI

Continue

Do you have any of the below conditions:

Medullary Thyroid Cancer(MTC) or family history of MTC

Multiple Endocrine Neoplasia Syndrome Type 2 (MEN 2) or family history of MEN 2

Serious allergic reaction to desired medications or their compounded components

Active cancer or chemotherapy / radiation in the last 6 months

Active drug or alcohol misuse

Significant eating disorders

Symptomatic bipolar disorder

Symptomatic schizophrenia

Pancreatitis

Diabetes Mellitus Type 1

Any kidney or liver disease (including hepatitis)

Active gallbladder disease

Chronic or persistent hypoglycemia with ranges < 60 mg/dl

Pregnant or planning to become pregnant or breastfeeding

Daily steroid use (ie Prednisone)

None of the above

Continue

Do you have any of the following conditions?

Select all that apply

High Cholesterol

Fatty Liver Disease

High Blood Pressure

Pre Diabetes / Type 2 Diabetes / Hbac 1 above 5.7

None of the above

Continue

If you have any known allergies, please list them here.

Continue

Congratulations! 🎉

You’ve been

pre-approved!

We only need a few more items! Let’s continue.

What weight loss initiatives have you tried in the past?

Select all that apply

Continue

Now let’s find out which treatments you’re eligible for

Before we explore treatments, let's gather a few basic pieces of information.

Your name*

What was your gender assigned at birth?*

Your email address* (you’ll receive your progress updates here)

Confirm your email address*

Your phone number

What type of consultation would you prefer?*

Continue

Upload Your ID

To continue, we need a photo of your valid driver’s license or passport.

Why do you need this?

Upload File

Max file size 10MB.

Uploading...

fileuploaded.jpg

Upload failed. Max size for files is 2 MB.

Make sure your photo

Shows the entire ID clearly

Is not blurry or dark

Has not been edited or filtered

Submit

Your ID has been successfully uploaded!

Your information is protected and used only for verification purposes.

Continue

Are you currently taking GLP-1?

Yes

No

Please upload proof of your current prescription

To continue, we need a photo or scan of your current prescription for GLP-1.

Why do you need this?

Upload File

Max file size 10MB.

Uploading...

fileuploaded.jpg

Upload failed. Max size for files is 10 MB.

Make sure your photo

Shows the entire label for your medication

Clearly shows the dose

Is not blurry or dark

Submit

Your prescription has been successfully uploaded!

Your information is protected and used only for verification purposes.

Continue

You’re almost done Jonh !

Here’s your treatment details:

Compounded Tirzepatide

Same active ingredient as Mounjaro® and Zepbound®.

Compounded Tirzepatide

Compounded Semaglutide

Recommended Dosing:

Trying to decide?

Semaglutide is single action; Tirzepatide is double action
Tirzepatide generally has fewer side effects
Tizepatide showed greater weight loss in clinical trials
Tirzepatide comes at a higher price point

Choose a plan

Quarterly

Max Saving

-

Monthly

-

Here’s a simple overview

Pre-paid monthly or quarterly
Weekly self-administered subcutaneous injections
Price includes consult, medication, supplies, shipping, and support
Cancel or change plans anytime

Total if prescribed

$

After checkout, a provider will review your information to determine if treatment is right for you. Prescription is not guaranteed.

Important: By clicking ‘Continue’ below, I agree to the Terms & Conditions and Privacy Policies. I understand that if I don’t qualify based on my provider interaction, I may not be prescribed medication. There is an $80 TeleHealth visit cost regardless of whether I receive medication.

Continue

If prescribed, where would you like us to send your treatment Jonh ?

Your medication will be shipped here

Shipping Address

Payment information:

You’ll be charged once you’ve been prescribed.

Card number

Promo Code:

Powered by CareValidate

To ensure the highest level of care, we’ve partnered with CareValidate for certain aspects of your experience. You may see their name on payment statements or portals, but rest assured, NewBodyRx remains your primary service provider.

Important: By clicking ‘Submit to provider’ you agree that:

You are purchasing an automatically renewing subscription and will be charged $385 if you are prescribed medication. By providing your card information, you allow CAREVALIDATE to charge your card for future payments in accordance with their terms. To ensure continuity of treatment your subscription will renew and you will be charged $385 approximately 4 weeks after each shipment until you cancel. Your monthly charge may fluctuate with medication and/or dosing changes. Your subscription will auto renew unless you cancel at least 3 days before the next renewal date. You may cancel your subscription by contacting customer support at Support@NewBodyRx.com. Any cancellation will take effect at the end of the current subscription period. You will not be able to cancel your first shipment. You will be charged $80 for your initial TeleHealth visit if you do not qualify for medication and no subscription will apply. If you select a quarterly plan your subscription is for renewing terms of 90 days. If you select the LifeStyle option you will be billed an additional $14.95 per month with your subscription plan.

Over 75 years of age?

Under 18 years of age?

Your BMI is less than 18.5

Your BMI is between 18.5-30

High cholesterol

Fatty liver disease

Kidney disease

High blood pressure

Heart failure

Lipid disorder

Cardiovascular disease

Pre-diabetes, type 2 diabetes, or HB A1c over 5.7

Metabolic Syndrome

Sleep apnea

Strong family history of heart disease

Why do we need your ID?

Why do we need proof of your prescription?

Thank you!

We have received your respond and we will send you an conformation mail.

Let's start with the basics

Do you have any of the below conditions:

What are your weight loss goals?

Do you have any of the following conditions?

Select all that apply

What other products / programs / medications might interest you?

Select all that apply

If you have any known allergies, please list them here.

Congratulations! 🎉

You’ve been

pre-approved!

We only need a few more items! Let’s continue.

What weight loss initiatives have you tried in the past?

Select all that apply

Now let’s find out which treatments you’re eligible for

Before we explore treatments, let's gather a few basic pieces of information.

Upload Your ID

To continue, we need a photo of your valid driver’s license or passport.

Make sure your photo

Shows the entire ID clearly

Is not blurry or dark

Has not been edited or filtered

Your ID has been successfully uploaded!

Your information is protected and used only for verification purposes.

Are you currently taking GLP-1?

Please upload proof of your current prescription

To continue, we need a photo or scan of your current prescription for GLP-1.

Make sure your photo

Shows the entire label for your medication

Clearly shows the dose

Is not blurry or dark

Your prescription has been successfully uploaded!

Your information is protected and used only for verification purposes.

You’re almost done Jonh !

Here’s your treatment details:

Compounded Tirzepatide

Same active ingredient as Mounjaro® and Zepbound®.

Recommended Dosing:

Trying to decide?

Semaglutide is single action; Tirzepatide is double action

Tirzepatide generally has fewer side effects

Tizepatide showed greater weight loss in clinical trials

Tirzepatide comes at a higher price point

Choose a plan

Max Saving

-

-

Here’s a simple overview

Pre-paid monthly or quarterly

Weekly self-administered subcutaneous injections

Price includes consult, medication, supplies, shipping, and support

Cancel or change plans anytime

Total if prescribed

$

$

After checkout, a provider will review your information to determine if treatment is right for you. Prescription is not guaranteed.

If prescribed, where would you like us to send your treatment Jonh ?

Payment information:

Powered by CareValidate

To ensure the highest level of care, we’ve partnered with CareValidate for certain aspects of your experience. You may see their name on payment statements or portals, but rest assured, NewBodyRx remains your primary service provider.

Important: By clicking ‘Submit to provider’ you agree that: