Wellness Intake

Luxe Med Wellness Intake

Confidential patient intake & consent form

Consent & Agreement

After submission, a Luxe Med provider will review your intake and reach out with next steps within 24 hours.

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Treatment Process

  • Registration ($100 fee) includes all appointments (e-consultation or phone consultation), shipping, and supplies for the program.
  • Invoices for the registration fee, questionnaire, and consent forms will be emailed.
  • Program payment invoice will be sent.
  • Injections will be ordered, and dosage and administration instructions will be provided via email.
  • A progress appointment will be scheduled (e-consultation or phone consultation) three weeks later to go over your results and determine next steps in your transformation.

Getting Started

This weight loss program is offered on a monthly basis. A provider will prescribe Semaglutide or Tirzepatide and guide you on how to self-administer the injections at home.

Treatment Process

  • Registration ($100 fee) includes all appointments (e-consultation or phone consultation), lab work, shipping, and supplies for the program.
  • Invoices for the registration fee, weight loss questionnaire, and consent forms will be emailed.
  • Bloodwork will be ordered through Quest Diagnostics once forms are submitted and the deposit is paid.
  • Lab results and the program payment invoice will be sent.
  • Medication will be ordered, and dosage and administration instructions will be provided via email.
  • A progress appointment will be scheduled (e-consultation or phone consultation) three weeks later to go over your results and determine next steps in your transformation.