Free Online Health Assessment

Let's get to know each other a bit better. What is your name?*

The next set of questions will help us determine if you qualify for prescription GLP-1 weight loss medications that could help you overcome some common barriers to weight loss.

What is your goal weight?*

Feet*
What is your height?
Inches*
This field is hidden when viewing the form
Height in Inches

What is your current weight in pounds?*
This helps us calculate your BMI. This will help us to determine your care path, so it’s important to be as accurate as possible.

Your current BMI is:

A BMI of over 25 is considered overweight.

Have you ever been diagnosed with, or treated for, any of the following medical conditions?*
THYROID CANCER/ MEN SYNDROME
PANCREATITIS
NONE
Some of these conditions may put people at increased risk for health complications with the prescription medication.
If none apply select None / NA.

Thanks! Based on your results, you are a good fit for our medical weight loss program.

You may also qualify for GLP-1 weight loss medications.

These medications work on the reward center of your brain to curb cravings for certain foods. In combination with diet and exercise, GLP-1s help our patients stick to a reduced-calorie diet and enhance the weight loss process.
Thanks! Based on your results, you may be a good fit for our combined medical weight loss and hormone therapy program.
Thanks! Based on your results, you are a good fit for our hormone therapy program.

Your next step is to schedule an initial appointment to explore medical history, discuss goals, and meet with a provider.
A patient care coordinator can help you get started and answer any questions. May we contact you to help you schedule your first appointment?*

Yes, text me.

Yes, call me.

No, thanks!
We are a HIPAA compliant company and we do not share your data—but we do need your consent to contact you! By selecting a "yes" option you are agreeing to receive communications from Blue Sky MD.

Please provide your email address*

Phone*

We offer both in-person office visits and flexible virtual appointments. Which Blue Sky MD location are you nearest to?*

In many cases we're able to bill insurance. However, we also offer affordable self-pay options. Which do you prefer?*
No worries! Thanks for exploring your options with us. We're always here to help answer questions as you do more research.