Check Eligibility — Solstice Clinical

Step 1 of 10

What's your full name?

About 3 minutes to complete.

Full Name

Please enter your full name.

Step 2 of 10

How can we reach you?

Email Address

Please enter a valid email address.

Phone Number

Please enter a phone number.

Step 3 of 10

How old are you?

Age

Please enter your age (must be 18 or older).

Step 4 of 10

Height and weight

We calculate your BMI automatically.

Height

Weight (lbs)

Please enter your height and weight.

Step 5 of 10

Have you previously used a GLP-1 medication?

Examples: Ozempic, Wegovy, Zepbound, Mounjaro, Saxenda, Victoza, Foundayo, or any compounded GLP-1 with or without additive

Please select an option.

Step 6 of 10

Do you have any medication allergies?

List medication allergies

Please select an option.

Step 7 of 10

Are you currently taking any prescription medications?

List current medications

Please select an option.

Step 8 of 10

Do you have any ongoing medical conditions?

List medical conditions

Please select an option.

Step 9 of 10

A few safety questions

Please answer honestly. Select all that apply to you.

I have ever had pancreatitis.

I or a family member have a history of medullary thyroid cancer (MTC) or MEN2.

I am currently pregnant, breastfeeding, or planning pregnancy.

I have severe gastroparesis or delayed stomach emptying.

Step 10 of 10

Before we submit

Both statements must be confirmed to continue.

I understand this consultation is for evaluation of Zepbound (tirzepatide) prescription eligibility. I confirm the information provided is accurate.

I understand Solstice Clinical does not provide emergency care or ongoing management of medication complications.

Both statements must be confirmed to continue.

What's your full name?

How can we reach you?

How old are you?

Height and weight

Have you previously used a GLP-1 medication?

Do you have any medication allergies?

Are you currently taking any prescription medications?

Do you have any ongoing medical conditions?

A few safety questions

Before we submit

You appear eligible for a Solstice Clinical consultation.

Thank you for completing the Solstice Clinical intake.