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jdmg@jdmedicalpllc.com
725-251-3488
725-251-3522
725-251-3523
What was your gender at birth?
Male
Female
Other
How tall are you?
Feet
3 ft
4 ft
5 ft
6 ft
7 ft
8 ft
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Inches
0 in
1 in
2 in
3 in
4 in
5 in
6 in
7 in
8 in
9 in
10 in
11 in
How much do you weigh?
What is your weight loss goal?
Lose 1 - 20 lbs for good
Lose 21 - 50 lbs for good
Lose over 50 lbs for good
Maintain my weight and get fit
Haven't decided
What is your birthdate? Your healthcare provider will need to know your age to help determine the appropriate medications for you.
What is your email address?
Please enter the best phone number to reach you on just in case your doctor has any questions regarding your medical information
What goals are you looking to accomplish?
Lose weight
Improve general health
Look better
Improve confidence
Increase energy
Better sex
What have you tried in the past?
Exercise
Dieting
Weight loss supplements
Intermittent fasting
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