Weight Loss in La Quinta, CA | CARE Esthetics La Quinta

Step 1 of 4

25%

Full Name(Required)

Phone(Required)

Email(Required)

Eligibility Questionnaire

Are you male or female?(Required)

What is your age?(Required)

What is your current weight?(Required)

What is your Current height?(Required)

Your BMI (Body Mass Index)

What is your weight loss goal?(Required)

General Questions

Do you have diabetes?(Required)

Are you currently on insulin?

What Type of Diabetes do you have?

Are you currently pregnant, breastfeeding, or planning to become pregnant?(Required)

Are you currently practicing a birth control method or perimenopausal?(Required)

Are you planning to travel soon?(Required)

Have you had any recent lab tests?(Required)

Please Specify:

Do you have any known allergies?(Required)

Please list your Allergies

Current Medications

Are you currently taking any of these medications or supplements?(Required)

Antacids

Androgens

Thyroid Medications (e.g., Levothyroxine)

NSAIDs (e.g., Ibuprofen, Naproxen)

Corticosteroids (e.g., Prednisone)

Anticoagulants (e.g., Warfarin)

Hormonal Medications (e.g., Birth Control Pills, Hormone Replacement Therapy)

Cancer Medications (specifically those affecting hormone-sensitive cancers)

Insulin or Insulin Secretagogues (e.g., Sulfonylureas)

Oral Diabetes Medications (e.g., Metformin)

Medications that Slow Gastrointestinal Motility (e.g., Anticholinergics)

Diuretics

None of the above

Current Conditions

Please select any conditions you have from the list below(Required)

Kidney disease

Liver disease

Gallbladder disease

Uncontrolled Diabetes

Polycystic Ovary Syndrome (PCOS)

Metabolic disorders

Gastrointestinal disorders (e.g., Crohn’s, colitis, gastroparesis, or IBD)

Hormone-related disorders

Cancer (hormone-sensitive)(e.g., Breast, Prostate)

Undiagnosed Vaginal bleeding

Cardiovascular conditions

Pancreatitis

Medullary thyroid carcinoma for Family History of MTC

Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)

None of the above

Hidden

Eligibility Results

Hidden

Ultimate Kickstart

Plan 1

Hidden

Rapid Transformation

Plan 2

Hidden

Long-Term Success

Plan 3

Proven WeightLoss for Men & Women

Book A FREE Consultation Today!

Eligibility Questionnaire

General Questions

Current Medications

Current Conditions

Eligibility Results