Initial Screening Medical History Final Steps
HIPAA Protected

GLP-1 weight loss care — led by a Mayo Clinic–trained physician

Monthly clinical oversight with real dose adjustments and guidance — so you're never left figuring it out alone.

  • Monthly follow-ups with a physician who knows your case
  • Support for side effects, questions, and next steps
  • Eligibility check takes 2–5 minutes
  • No payment required to get started

You'll answer a few brief questions. If you appear eligible, you'll see your result right away — then complete your intake for physician review.

HIPAA Compliant
Physician-Led Care
LegitScript Certified

GLP-1 weight loss care — led by a Mayo Clinic–trained physician

Monthly clinical oversight with real dose adjustments — so you're never left figuring it out alone.

Monthly physician follow-ups
Side effect support & guidance
Eligibility check: 2–5 min
No payment required to start
HIPAA Compliant · Physician-Led Care · LegitScript Certified

Basic Information

Your information is protected with HIPAA-compliant systems. This will take just a few minutes.

By filling in your information below, you confirm that you have read and agree to Praxiom Health's Terms of Service and acknowledge the Privacy Policy.
Please enter your first name.
Please enter your last name.
Please enter a valid email address.
You must be 18 or older.
Please enter a valid date of birth (18+).
ft
in
Please enter your height.
lbs
Your most recent measurement is fine.
Please enter your weight.

Safety Check

We ask these questions to ensure safe, appropriate care. If any apply, we'll guide you to the best next steps for your health.

All questions are required. Your honest answers help us provide the safest care possible.
Have you ever been diagnosed with Type 1 diabetes? *
Please select an answer.
Are you currently pregnant, planning pregnancy soon, or breastfeeding? *
Please select an answer.
Do you have a family history of medullary thyroid cancer (MTC) or Multiple Endocrine Neoplasia type 2 (MEN2)? *
Please select an answer.
Have you had bariatric surgery in the past 6 months or been hospitalized recently? *
Please select an answer.
Have you ever been diagnosed with pancreatitis? *
Please select an answer.
Checking eligibility...
Checking eligibility...

Your Health & Lifestyle

We ask these to make sure your care plan is safe and effective. If none apply, write "none."

This field is required. Enter "none" if not applicable.
This field is required. Enter "none" if not applicable.
This field is required. Enter "none" if not applicable.
Have you had any surgeries in the past? *
Please select an answer.
Please list your previous surgeries with approximate dates.
Please select an option.

Your Past Weight Loss Journey

Your experience and concerns help us understand what works best for you.

This field is required. Enter "none" if not applicable.
Have you used any weight loss prescription medications in the past 30 days? *
Please select an answer.
Please enter a valid last dose date.
Click to choose a file
Any file type, up to 20 MB

Mental Health Check

Because certain medications can affect mood, we ask every patient this question. Your honesty helps us help you.

Your response is confidential and will only be used to ensure your safety and wellbeing.
In the past two weeks, have you had thoughts about harming yourself or others? *
Please select an answer.

Support is Here for You

If you are in crisis, please call or text 988 for immediate, confidential help — available 24/7.

Our care team will also reach out to you soon with support resources.

988 Suicide & Crisis Lifeline — Call or Text 988
hello@praxiomhealth.com

Personalizing Your Plan

Your care is built around your goals and what matters most to you.

Please select your primary goal.

A1C Results

This helps your care team understand your metabolic health history.

Do you have a copy of your most recent A1C results? *
Please select an answer.
Click to choose a file
Any file type, up to 10 MB per file — max 3 files
Please upload your A1C results to continue.

Military Affiliation

We proudly offer special rates to military personnel

Do you have any affiliation with the military (active duty, veteran, or spouse/dependent)? *
Please select an answer.

Military Verification

Upload documentation so our team can confirm your military rate eligibility.

If you plan to take advantage of our military program for compounded medication, documentation is required to verify eligibility and will be shared with our pharmacy partners for enrollment.

Please upload one of the following:

  • DD214
  • Discharge paperwork
  • Military ID

If you are a spouse or dependent, please also include:

  • Spouse: Marriage certificate
  • Dependent: Birth certificate
Click to choose a file
Any file type, up to 20 MB
Please upload military verification documentation.

Treatment Preference

Tell us which medication path best fits what you're looking for.

Brand name
Compounded
Not sure
Please select the medication path you prefer.

Final Step to Confirm Your Treatment

Because you selected a compounded medication, we need to confirm a few final details before moving forward.

Compounded medications may only be prescribed when at least one qualifying medical reason is present. Please review the following questions carefully and select any that apply to you. If none apply, our clinical team will review your information and recommend the safest and most appropriate option for you.

In this next step, you will:
  • Upload a government-issued ID
  • Confirm your address and phone number
  • Upload a current photo of yourself
  • Answer a few brief medical questions

This usually takes less than 3 minutes. We appreciate your trust in Praxiom Health.

Address & Phone

Confirm where your medication and care updates should be routed.

Please enter your street address.
Please enter your city.
Please select your state.
Please enter your ZIP code.
Please enter your phone number.

ID Upload

For verification purposes, please upload your government issued photo ID.

Click to choose a file
Any file type, up to 20 MB
Please upload your government issued photo ID.

Photo Upload

Please upload a current photo so the clinical team can complete identity and safety review.

Click to choose a photo
Any file type, up to 20 MB
Please upload a current photo of yourself.

Indications for Compounded GLP-1's

Compounded medications may only be prescribed when at least one qualifying medical reason is present.

Please review the following questions carefully and select any that apply to you. If none apply, our clinical team will review your information and recommend the safest and most appropriate option for you.
Headaches/Migraines
Do you have a diagnosis of headaches/migraines syndrome? Do you get headaches frequently without a diagnosis? Have you experienced headaches while on this medication previously? *
Please select an answer.
Acid Reflux/Heartburn/GERD
Do you have an official diagnosis of the above? Do you experience these frequently without a diagnosis? Have you experienced these previously while on a GLP-1? *
Please select an answer.
Fatigue
Do you have a diagnosis of Chronic Fatigue? Do you often experience fatigue or feelings of being tired without a diagnosis? Have you previously felt fatigued on a GLP-1? *
Please select an answer.
Nausea
Are you prone to experiencing nausea easily? Have you had nausea while previously on a GLP-1? *
Please select an answer.
Digestive Health
Do you have a diagnosis of IBS? Do you experience IBS symptoms without a diagnosis? Do you experience constipation, gas, or bloating frequently? *
Please select an answer.

Almost There!

Final Step to Submit to Insurance

You're almost finished.

Because you selected a brand-name medication through insurance (or your plan requires prior authorization), we need to gather a few additional details before submitting your prescription.

Insurance companies often require specific documentation before approving weight loss medications. Many plans require proof of 3-6 months of medically supervised diet and exercise before approval.

In this next step, you will:
  • Upload a government-issued ID
  • Confirm your address and phone number
  • Upload a current photo of yourself

Please note: If your insurance requires a prior authorization, there is a $74.99 administrative fee to prepare and submit this request on your behalf.

Address & Phone

Confirm where our team can reach you during insurance review.

Please enter your street address.
Please enter your city.
Please select your state.
Please enter your ZIP code.
Please enter your phone number.

ID Upload

For verification purposes, please upload your government issued photo ID.

Click to choose a file
Any file type, up to 20 MB
Please upload your government issued photo ID.

Photo Upload

Please upload a current photo so the clinical team can complete identity and safety review.

Click to choose a photo
Any file type, up to 20 MB
Please upload a current photo of yourself.

Almost There!

Let's Complete Your Intake

You indicated that you'd like to speak with someone before making a decision.

We're happy to walk you through your options.

First, we'll collect a few final details (ID verification, contact information, and a photo) to complete your intake and securely create your chart.

Once that's done, our nurse will reach out to review your information and discuss the best treatment options for you.

We look forward to connecting with you.

Address & Phone

Confirm where our nurse can reach you to review options.

Please enter your street address.
Please enter your city.
Please select your state.
Please enter your ZIP code.
Please enter your phone number.

ID Upload

For verification purposes, please upload your government issued photo ID.

Click to choose a file
Any file type, up to 20 MB
Please upload your government issued photo ID.

Photo Upload

Please upload a current photo so the clinical team can complete identity and safety review.

Click to choose a photo
Any file type, up to 20 MB
Please upload a current photo of yourself.

How Did You Hear About Us?

We'd love to know how you found Praxiom Health.

Please select an option.

Before We Review Your Case

Here's how the review and payment process works.

Your card won't be charged until the physician reviews your case.

Your intake is reviewed by our nursing team, then a licensed Praxiom physician evaluates your history and preferences to determine if you're a suitable candidate for GLP-1 medication.

We'll reach out once your review is complete — typically within 24 to 48 hours during the work week.

IF YOU ARE A CANDIDATE

You will be charged based on which type of GLP-1 medication the physician decides is better suited for you:

For compounded
You will be charged a monthly, all-inclusive package (consult, medication, shipping, and pharmacy handling), starting at $214.99 (Semaglutide) or $314.99 (Tirzepatide).

For brand-name
You will be charged a consultation fee of $74.99. Brand-name GLP-1 medication must be purchased by you from a local retail pharmacy or directly from the manufacturer. We will send a prescription to whichever you choose.

IF YOU ARE NOT A CANDIDATE

For your safety, your physician may decide that you are not a suitable candidate for GLP-1 medication.

If so, a one-time $24.99 clinical review fee is applicable to cover the physician's time. Nothing else.