Thank you for choosing Novi!
Your intake form helps our care team understand your health background so we can safely personalize your treatment plan. Completing it only takes a few minutes and ensures your visit goes smoothly.
Before You Begin
Make sure you have:
A few quiet minutes to complete the form
Your recent height, weight, and medical details
A stable internet connection
Tip: Answer each question carefully and honestly. Your responses help us confirm your eligibility and create a care plan that’s safe and effective for you.
Step 1: Basic Information
Confirm your age, weight, height, and location.
Patients ages 18–74 with a BMI of 22 or higher may continue with the form.
Your state of residence determines which medication options are available, as some states have specific prescribing rules.
Step 2: Health Background
Answer questions about your overall health, including conditions such as pregnancy, liver or kidney disease, certain cancers, or eating disorders.
If none apply, select “None of the above” and move forward.
Step 3: Conditions That Need Doctor Review
Some answers don’t prevent you from starting care but let our doctor know that follow-up may be needed. Examples include:
Recent childbirth
Digestive conditions such as Crohn’s or ulcerative colitis
Prior weight-loss surgery
Long-term use of pain medications
Our team may follow up to ensure your plan is safe.
Step 4: Current Health Details
Provide information about recent surgeries, hospitalizations, or conditions such as diabetes, heart or thyroid concerns, or gallbladder issues.
This helps your clinician understand how to best support your health.
Step 5: Medications and Weight History
Share details if you currently or recently used weight-loss medications (name, dose, last use date).
You may also upload a photo of your medication pen or vial to confirm information.
If you haven’t taken weight-loss medications, continue to questions about your weight-related health and goals.
Step 6: Medication and Allergy History
List all prescription or over-the-counter medications and any known allergies.
Include any current or recent pain medications.
Accurate information helps your clinician avoid interactions and choose safe treatment options.
Step 7: Lifestyle and Progress
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Answer questions about your weight-management journey, including:
Past diet or exercise programs
Willingness to make nutrition or activity changes
Weight changes over the past year
These questions help us personalize your care and set realistic goals.
Step 8: Medication Preferences
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Share what’s important to you when considering treatment, such as:
Preference for no injections
Support with energy or sleep
Focus on muscle preservation or hormonal balance
If unsure, you can choose to discuss options directly with a clinician.
Step 9: Final Notes and Submission
Add any additional information for your doctor.
Review your answers carefully and click Submit.
You’ll see a confirmation once your form is successfully sent.
Our team will review your responses and contact you via email or text if anything else is needed.
Need Help?
If you have questions or need extra support, we’re always here to help.
💬 Prefer live chat? We’re happy to assist you in real time. Click the chat icon at the lower-right corner of this page to start a conversation.
Hours of operation: Monday–Sunday, 8 AM – 8 PM EST
Thank you for completing your intake form. Your careful answers help us provide safe, personalized care and get you started quickly.
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