Semaglutide Inquiry Form

Please fill out the questionnaire below. You will then receive instructions on how to proceed.
Please note we require a consultation with a medical professional, either on site or through our zoom app before prescribing any medications.
Semaglutide Inquiries
Please enable JavaScript in your browser to complete this form.
Name
Gender

Interest and Awareness:

Have you ever used any GLP-1 receptor agonists before?

Health Overview:

Are you currently taking any medications or supplements?
Do you have a history of thyroid cancer or a family history of medullary thyroid carcinoma?
Have you ever been diagnosed with pancreatitis?

Lifestyle Questions:

Expectations and Consent:

Are you aware of the potential side effects and agree to consult with a healthcare professional before starting treatment?

Get in Touch

Check out the other services at our Ridgefield Medspa

Location

228 Simons St
Ridgefield, WA 98642

Email

Phone

(360) 513-6095

}

Hours

Monday – Friday: 9 am – 7:00 pm

Saturday: 11 am – 5:00 pm

Subscribe to Our Newsletter