GLP-1 Eligibility – Vitality Vault Online Clinic

Let's Check Your Eligibility

Please answer a few questions so that our medical providers can evaluate your GLP-1 eligibility. This will take 2 minutes or less!

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#1. Why are you looking to lose weight? (Check all that apply)

To feel better about myself To improve my physical health To have more energy To look and feel my best

#2. What GLP-1 medications are you interested in?

Semaglutide + Vitamin B12 Tirzepatide + Vitamin B6

#3. How much weight would you like to lose?

Less than 20 lbs 21-50 lbs 51+ lbs

#4. Are you 18 years old or older?

Yes No

#5. What's your assigned sex at birth?

Male Female

Are you pregnant, breastfeeding, or planning to be pregnant in the next few months?

Yes No

#6. Do you have or have had any of the following medical conditions? (Check all that apply)

Pancreatitis Type 1 Diabetes Slow gastric emptying None of the above

#7. Do you have or have had any of the following medical conditions? (Check all the apply)

Thyroid tumors Medullary thyroid carcinoma (MTC) Multiple endocrine neoplasia syndrome (MENS) None of the above