Step 1 of 9

Let's start with your name

We want to personalize your experience

First Name *

Email Address *

Please fill out all required fields

Step 2 of 9

Which path best describes your goals?

Choose the program that fits what you're looking for

GLP-1 Weight Loss Plan

Medical GLP-1 access for weight loss — with optional Peptide add-ons

Peptide Therapy

Peptide support for metabolism, energy, and repair (non-GLP)

ClarityRx Coaching

Full GLP-1 program + coaching for nutrition, habits, and lifestyle support

Please select your program path

Step 3 of 9

Which GLP-1 medication are you interested in?

Select the option that best fits your goals

Tirzepatide (Mounjaro / Zepbound)

starting at $350/mo

Dual-pathway option (GIP + GLP-1) designed to support appetite control and metabolic health.

Semaglutide (Ozempic / Wegovy)

starting at $250/mo

GLP-1 option designed to support appetite control, cravings, and steady weight loss progress.

Microdose

starting at $250/mo

Microdosing gives you the benefits of GLP-1's at the lowest therapeutic range. Only available at the medical provider's discretion.

Eligibility and treatment require licensed provider review.

Please select a GLP-1 medication option

Step 3 of 9

Let us know your gender

This helps us ask relevant medical screening questions

Female

Male

Prefer not to say

Please select your gender

Step 4 of 9

Safety First

Are you currently pregnant or breastfeeding?

No

Yes, I'm pregnant

Yes, I'm breastfeeding

Please answer this question

Step 5 of 9

Medical History Screening

Do you have a personal history of any of the following? (Select all that apply)

None of these apply to me

Severe gastrointestinal disease

Such as gastroparesis

Gallbladder disease

Or gallbladder removed due to stones/inflammation

Cardiovascular Disease

Fatty Liver Disease

PCOS

History of Pancreatitis

Please select at least one option

Step 6 of 9

Medical History Screening (Continued)

Do you have a personal history of any of the following? (Select all that apply)

None of these apply to me

Medullary Thyroid Cancer (MTC) or MEN2

Personal or family history

Type 1 Diabetes

Or history of diabetic ketoacidosis (DKA)

Current Eating Disorder

Anorexia/bulimia/binge eating or active treatment

Active Cancer Treatment

Currently being treated (not including minor skin cancers)

Allergies to B12 or Glycine

Please select at least one option

Step 7 of 9

Let's calculate your BMI

This helps us determine program eligibility

Height *

Feet

Inches

Weight (lbs) *

--

Your BMI

Please enter valid height and weight

Step 7 of 9

Which goals/peptides are of interest?

Select all that apply to help us personalize your recommendations

Fat Loss & Metabolic Support

AOD-9604, MOTS-C, Sermorelin

Cellular Energy & Longevity

NAD+, MOTS-C

Metabolic & Mitochondrial Support

NAD+, MOTS-C

Mood & Stress Relief

Semax/Selank

Healing & Tissue Repair

BPC-157/TB-500, GHK-CU

Detox & Immunity Support

Glutathione

Skin, Hair & Tissue Repair

GHK-CU

Growth Hormone Support & Body Composition

Sermorelin

Please select at least one peptide goal

Step 8 of 9

Have you tried GLP-1 medications before?

Help us understand your experience

Never tried them

I'm completely new to GLP-1s

Tried but stopped

Side effects or other reasons

Currently using

Looking for better support or cost

Please select your experience level

Step 9 of 9

Tell us about your current GLP-1

This helps us provide better guidance

What medication are you currently taking? *

What is your current dose? *

How long have you been taking it?

Please fill out all required fields

Step 9 of 9

What level of support do you need?

We offer both medication access and full coaching programs

Medication Access Only

I just need the prescription and supplies

Medication + Coaching

I want guidance, accountability, and support

Please select your preferred support level

Safety First

Based on your responses, GLP-1 medications may not be appropriate at this time. Your safety is our top priority, and we want to ensure any treatment plan is right for you.

Let's schedule a personal consultation to discuss your goals and explore alternative wellness options that may be a better fit.

Schedule a Call with Clarity

In case you incorrectly answered a question,

Questions? Email me at [email protected]

Final Step

When would you like to start?

Most clients begin within 7-10 days

As soon as possible

I'm ready to begin right away

Within a week

I need a few days to prepare

Within a month

Just exploring my options

Please select your preferred timeline

You're a Great Fit for ClarityRx!

Based on your responses, you qualify for our comprehensive coaching programs that combine GLP-1 medication with personalized support.

ClarityRx Coaching pairs physician-supervised GLP-1 therapy with expert guidance on nutrition, habits, and lifestyle—so you get real, lasting results with accountability every step of the way.

What's Included:

✓ GLP-1 medication with medical oversight
✓ Weekly coaching check-ins
✓ Custom nutrition blueprint
✓ Accountability & ongoing support

Explore ClarityRx Coaching Programs

Want to discuss your options first?

Schedule a Free Clarity Call

Or continue to see your personalized results:

Your Personalized Results

Great news!

Based on your responses, here are the programs we recommend:

Have questions or want personalized guidance?

Schedule a Free Clarity Call

Or email me at [email protected]