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About Us

Our Services

Home

About Us

Our Services

MedMembership

Weight Loss Solutions Service

Take the First Step Toward a Healthier You

Welcome to MedMembership!

WEIGHT LOSS SOLUTIONS SERVICE Features:

Semaglutide or Tirzepatide options: Choose from effective FDA-approved medications for weight loss support.
Costs varies on dosing and advised medication treatment.

Customized weight management programs: Tailored strategies based on your unique health profile, ensuring sustainable results.

Nutritional counseling and meal planning: Receive personalized meal plans and expert advice to support your weight loss journey.

Regular monitoring and adjustments: We track your progress and adjust your plan as necessary to ensure continued success.

We are excited to be part of your journey toward complete health and wellness. Please take a few moments to fill out this intake form for Weight Loss Solutions Service. Your answers will help us tailor our services to best meet your needs and ensure a smooth start to your care with us.

Name *

First Name

Last Name

Email *

Phone *

(###)

###

####

Birthdate *

(###)

###

####

Gender *

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Referral/Source

What services are you interested in?

Weight Loss Solutions

What are you hoping to accomplish through our Weight Loss Solutions Service? *

Weight Management *

Are you currently working with a provider on weight management?

YES

Diet and Exercise: *

How would you describe your typical diet?

Healthy

Average

Unhealthy

Are you currently taking any medications?

If yes, please list:

Do you have any allergies?

If yes, please list:

Description of any health symptoms you are currently experiencing:

Do you exercise regularly? *

YES

Sleep and Stress: *

Do you experience any sleep difficulties?

YES

On a scale of 1 to 10, how would you rate your stress level? (1 = Low, 10 = High) *

Terms and Conditions *

I hereby consent to the use of telemedicine services, which may include consultations and follow-ups via secure video or phone calls. I understand that MedMembership operates on a direct-pay model and does not bill insurance for services. However, I understand that some services (such as lab work) may be billable through my insurance, depending on my plan. I acknowledge that MedMembership may require a deposit for securing my initial appointment, which will be applied toward my services at checkout. I agree to provide accurate and up-to-date information and will notify MedMembership of any changes in my health, medications, or insurance. By signing below, I acknowledge that the information provided is accurate to the best of my knowledge and that I consent to the use of MedMembership’s services in accordance with the policies outlined.

Next Steps:

Once you’ve completed the form, our team will review your information and reach out within 24 hours to process your records and schedule appointment depending on the service chosen. Thank you for choosing MedMembership! We look forward to supporting you on your health journey. Thank you for choosing MedMembership! We look forward to supporting you on your health journey.

Thank you!

Location:

229 Rugged Creek Dr
Stockbridge, GA 30281

Contact Us:

info@medmembership.com
(678)-916-4100

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