Quiz 2 | Freya | All things GLP-1

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Answer the following questions to find out if you qualify for the Freya weight loss program.

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Weight loss made easy

Answer the following questions to find out if you qualify for the Freya weight loss program.

What is your height?

Feet(Required)

Inches(Required)

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Feet(old)(Required)

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Inches(old)(Required)

What is your weight? (in lbs)(Required)

Please enter a number from 30 to 1400.

What is your goal weight?(Required)

Please enter a number from 30 to 1400.

Please enter a number less than your weight

What is your sex?(Required)

Female

Male

Date of Birth(Required)

Month

Day

Year

Are you currently pregnant or breastfeeding?

Yes

Health Questions 1: Do any of these apply to you?(Required)

End-stage kidney disease (on or about to be on dialysis)

End-stage liver disease (cirrhosis)

Cancer (active diagnosis, active treatment, or in remission or cancer-free for less than 5 continuous years - does not apply to non-melanoma skin cancer that was considered cured via simple excision)

Severe gastrointestinal condition (gastroparesis, blockage, severe or uncontrolled inflammatory bowel disease)

Current diagnosis of or treatment for alcohol, opioid, or substance use disorder/dependence

None of the above

Health Questions 2: Do any of these apply to you?(Required)

Gallbladder disease

Hypertension (high blood pressure)

Seizures

Type 2 diabetes (not on insulin)

Type 2 diabetes (on insulin)

Type 1 diabetes

Diabetic retinopathy (diabetic eye disease), damage to the optic nerve from trauma or reduced blood flow, or blindness

Use of the blood thinner warfarin (Coumadin/Jantoven)

History of or current pancreatitis

Personal or family history of thyroid cyst/nodule, thyroid cancer, medullary thyroid carcinoma, or multiple endocrine neoplasia syndrome type 2

Depression

Tumor/infection in brain/spinal cord

Liver disease, including fatty liver

Kidney disease

Elevated resting heart rate (tachycardia)

Coronary artery disease or heart attack/stroke in last 2 years

Congestive heart failure

QT prolongation or other heart rhythm disorder

Hospitalization within the last 1 year

None of the above

Do you take any medication?(Required)

Yes

Please list the medication and dosage that you are prescribed

Have you had a gastric bypass in the last 6 months?(Required)

Yes

How would you describe your current approach to weight management?(Required)

Actively managing

Some efforts

No active efforts

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heightInches

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BMI

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lbsToLose

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Monthly weight loss

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low

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high

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monthsToGoal

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goalBucket

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goalBucket

Sorry, based on the answers you provided we are not able to prescribe treatment. Your disqualifying answers are listed below:

If you made a mistake, you can go back and update your answers.

If the information you gave was correct, we may be able to prescribe an alternative treatment.

I made a mistake

Join thousands of others who’ve lost weight with Freya

NAME

Rafaella

LOST

80lbs

“Seamless experience!!! 8 months with them helped me lose 80lbs, on top of extreme care from their doctors and dietician. 10/10 recommend. Freya changed my life.”

NAME

Bella

LOST

100lbs

“Overall I've had such a great experience with Freya, from my first order to a year later at my dream weight. Any questions and concerns I had were immediately answered and I felt so supported through my whole weight loss journey. Life changing!”

NAME

Honey

LOST

50lbs

“The Freya team are a pleasure to work with! I’m 5 months in now, down 50 pounds and feeling amazing!”

Do you have any allergies?(Required)

Yes

Please list your allergies

Have you taken any of the following medication in the last 60 days?(Required)

Semaglutide (Ozempic, Wegovy, Rybelsus)

Tirzepatide (Zepbound, Mounjaro)

None of the above

What was the most recent dose you took?

Month 1 (0.25mg)

Month 2 (0.5mg)

Month 3 (1mg)

Month 4 (1.75mg)

Month 5 (2.5mg)

Not sure

Other dose

What was the most recent dose you took?

Month 1 (2.5mg)

Month 2 (5mg)

Month 3 (7.5mg)

Month 4 (10mg)

Month 5 (12.5mg)

Month 6 (15mg)

Not sure

Other dose

Please select from the following options that you would like your provider to consider.

Stay at the same dose or equivalent

Increase dosage

Decrease dosage

Have you experienced side effects from your current medication?

Yes

Please describe the side effects you have experienced

Do you have a specific GLP-1 medication in mind?(Required)

Semaglutide

Tirzepatide

I don't have a preference

Do you have any other medical condition(s), a history of prior surgeries, or anything else you'd like to tell your doctor?(Required)

Yes

Please provide details.

Let's find out if you're eligible for weight loss treatment.

BMI:

Current weight: lbs

Goal weight: lbs

You are a strong candidate for medical weight loss with a 98% chance of treatment success if you qualify.

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First Name Last Name

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Phone Number(Required)

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