Which program are you interested in?
Select the one that best fits your goals. You can add more later.
Your answers are private and HIPAA-protected
Let's start with the basics.
This helps your physician personalize your protocol.
What is your current height and weight?
We use this to calculate your BMI and confirm eligibility for tirzepatide.
Do you have any of the following conditions?
Select all that apply. This helps your physician prescribe safely.
✓
Personal or family history of thyroid cancer (MTC)✓
History of pancreatitis✓
Type 1 or Type 2 diabetes✓
High blood pressure✓
High cholesterol✓
Heart disease or history of heart attack✓
Kidney disease✓
Liver disease✓
Currently pregnant or breastfeeding✓
Depression or anxiety (currently treated)None of the above apply to me
Almost done. How should your physician reach you?
Your physician will review your intake and contact you within 24 hours.
By continuing, you agree to ZENKAI's Terms of Service, Privacy Policy, and Medical Consent. A licensed physician will review your information and contact you. Submitting this form does not create a physician-patient relationship.
Your information is encrypted and HIPAA-protected
Your assessment is complete.
A licensed ZENKAI physician will review your intake and contact you within 24 hours. Check your email for a confirmation.
Program—
Name—
Email—
Review timeWithin 24 hours
We want to make sure you get the right care.
Based on your answers, one of our conditions may prevent us from prescribing safely at this time. A physician will still review your case and reach out to discuss your options. You will not be charged.
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