Health Assessment

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

Nice to meet you !

Blue Sky MD has been helping thousands of patients find success with their health outcomes since 2008, so we know a thing or two about losing weight and optimizing hormones the right way.

What issues can we help you address?*

LOSING WEIGHT

HORMONE THERAPY

BOTH

Our age influences our metabolism and hormonal health. What is your date of birth?*

MM slash DD slash YYYY

Sex also plays a key role in hormones and metabolism. Which one best describes you?*

MALE

FEMALE

DECLINE TO ANSWER

Our ability to lose weight is up to 80% determined by genetics.

An individualized approach to weight loss can help us work with what we have.

How long have you been trying to lose weight?

MY WHOLE LIFE

SEVERAL YEARS

6-12 MONTHS

1-6 MONTHS

NEVER

Has anyone in your family struggled with their weight?*

Choose as many as you’d like

FATHER

CHILD

MOTHER

UNCLE/AUNT

SIBLING

COUSIN

GRANDPARENT

NONE

The average Blue Sky MD member loses about 10% of their body weight after 3 months on the program.*

Losing as little as 5% can reduce your risk of developing health problems like type II diabetes and heart disease.

The next set of questions will help us determine if you may be suffering from a hormone imbalance.

Have you been feeling slow, sluggish, or lacking energy?*

YES

NOT SURE

Are you currently experiencing menopause or hot flashes? If so, for how long?*

A FEW WEEKS

6-12 MONTHS

MORE THAN A YEAR

Are you currently experiencing erectile dysfunction? If so, for how long?*

A FEW WEEKS

6-12 MONTHS

MORE THAN A YEAR

Have you recently experienced a sudden decrease in physical strength or muscle mass?*

YES

NOT SURE

Have you recently experienced a sudden loss of libido?*

YES

NOT SURE

Unlike other weight loss programs, Blue Sky MD isn't one-size-fits-all.

We like to craft your plan using by understanding underlying issues like hormones, behaviors, and emotional health.

Weight needs to be approached from a healthcare perspective...

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

What is your goal weight?*

What is your 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 Body Mass Index score is {BMI:96}

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 FDA-approved 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, Semaglutide helps our patients stick to a reduced-calorie diet and enhance the weight loss process.

Thanks! Based on your results, you are 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 would like to send you the occasional email! 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?*

For most patients, 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 Blue Sky. We're always here to help answer questions as you do more research.