Quiz | Freya | All things GLP-1

Step 1 of 19

What is your weight loss goal?

What is your weight loss goal?(Required)

Lose 10 lbs for good

Lose 20 lbs for good

Lose 30 lbs for good

Lose 50 lbs for good

Lose over 50+ lbs for good

Maintain my weight and get fit

We've helped over 100,000+ patients on their weight loss journey.

Let’s answer a few quick questions to kickstart your weight loss journey and help you lose 20% of your body weight!

What is your current height & weight?

Feet(Required)

Please enter a number from 3 to 8.

Inches(Required)

Please enter a number from 0 to 11.

Weight (in lbs)(Required)

Please enter a number from 20 to 1500.

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Total inches

Your BMI

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Monthly weight loss

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Goal month

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Total expected weight loss

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Month 1 weight

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Month 2 weight

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Month 3 weight

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Month 4 weight

What is your gender?

What is your gender?(Required)

Male

Female

What is your date of birth?

DOB(Required)

Month

Day

Year

Where are you located?

Select a state(Required)

We cannot currently service your state. Please email contact@freyameds.com if you have any questions.

Do any of the following apply to you?

Do any of the following apply to you?(Required)

None of the below

Currently or possibly pregnant, or actively trying to become pregnant

Breastfeeding or bottle-feeding with breastmilk

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

End-stage liver disease (cirrhosis)

Current or prior eating disorder (anorexia/bulimia)

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

History of organ transplant on anti-rejection medication

Severe gastrointestinal condition (gastroparesis, blockage, inflammatory bowel disease)

Type 2 diabetes (on insulin)

Type 1 diabetes

History of or current pancreatitis

Gallbladder disease

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

QT prolongation or other heart rhythm disorder

Kidney disease

You're in good hands!

Freya has been featured in leading health and lifestyle publications.

Are you currently taking or recently (within the last 3 months) taken any kind of GLP 1 medication.

Are you currently taking or have recently (within the last 3 months) taken a GLP-1 medication?

Yes

Please list your most recent medication name and dose to the best of your ability. If you don't know that's okay!

Medication name

Dose

Do you currently take any medications? If so, please include name, dose, and frequency of all your medications.

Do you currently take any medications? If so, please include name, dose, and frequency of all your medications.(Required)

Yes

Please include name, dose, and frequency of all your medications.

Add details(Required)

Do you have any medication allergies?

Do you have any medication allergies?(Required)

Yes

Please list your medication allergies.

Add details(Required)

Do you have any further information which you would like the doctor to know?

Do you have any further information which you would like the doctor to know?(Required)

Yes

Please do not include urgent or emergency medical information here, as this is not reviewed immediately.

Add details(Required)

What is your first and last name?

First Name(Required)

Last Name(Required)

What is your email?

Important: Please provide your best email as this is where all doctor communications will take place

Email(Required)

Enter the password you will use to log into your account

Password(Required)

Enter Password Confirm Password

What is your phone number?

Phone(Required)

This field is hidden when viewing the form

Phone raw

I agree to receive texts regarding order updates, shipment notifications and messages from my provider.(Required)

GLP-1 Quiz

What is your weight loss goal?

We've helped over 100,000+ patients on their weight loss journey.

What is your current height & weight?

What is your gender?

What is your date of birth?

Where are you located?

We cannot currently service your state. Please email contact@freyameds.com if you have any questions.

Do any of the following apply to you?

You're in good hands!

Are you currently taking or recently (within the last 3 months) taken any kind of GLP 1 medication.

Please list your most recent medication name and dose to the best of your ability. If you don't know that's okay!

Do you currently take any medications? If so, please include name, dose, and frequency of all your medications.

Please include name, dose, and frequency of all your medications.

Do you have any medication allergies?

Please list your medication allergies.

Do you have any further information which you would like the doctor to know?

Please do not include urgent or emergency medical information here, as this is not reviewed immediately.

What is your first and last name?

What is your email?

Enter the password you will use to log into your account

What is your phone number?