[HideElement 48,56,57,55 in #o1f977ebf093a] [IfAnchor #current.sema] [FillField f2828 with "Semaglutide (ie Ozempic® or Wegovy®)"] [FillField f2208 with "Select..."] [/IfAnchor] [IfAnchor #current.tirze] [FillField f2828 with "Tirzepatide (ie Mounjaro® or Zepbound®)"] [FillField f2208 with "Select..."] [/IfAnchor] [IfAnchor #current.no] [FillField f2828 with "I’m not currently taking a GLP-1 medication"] [FillField f2208 with "Select..."] [/IfAnchor] [IfField f2828 contains "Semaglutide"] [FillField f2207 with "Select..."] [ShowElement 56 in #o1f977ebf093a] [HideElement 52 in #o1f977ebf093a] [/IfField] [IfField f2828 contains "Tirzepatide"] [FillField f2207 with "Select..."] [ShowElement 57 in #o1f977ebf093a] [HideElement 53 in #o1f977ebf093a] [/IfField] [IfField f2828 contains 'not currently taking'] [ShowElement 55 in #o1f977ebf093a] [HideElement 54 in #o1f977ebf093a] [FillField f2207 with "No"] [/IfField] [IfField f2828 not "Select..." and f2828 not "I’m not currently taking a GLP-1 medication"] [ShowColumn 69,68,70,71 in #o1f977ebf093a] [/IfField] [IfAnchor #glp1.yes] [FillField f2207 with "Yes"] [/IfAnchor] [IfAnchor #glp1.no] [FillField f2207 with "No"] [/IfAnchor] [IfField #o1f977ebf093a-f2207 not "Yes"] [ShowElement 64 in #o1f977ebf093a] [/IfField] [IfField #o1f977ebf093a-f2207 not "No"] [ShowElement 66 in #o1f977ebf093a] [/IfField] [IfField #o1f977ebf093a-f2207 is "Yes"][ShowElement 65 in #o1f977ebf093a][/IfField] [IfField #o1f977ebf093a-f2207 is "No"][ShowElement 67 in #o1f977ebf093a][/IfField] [IfField (#o1f977ebf093a-f2207 is "No") OR (#o1f977ebf093a-f2207 is "Yes" AND f2229 not 'Select...' AND f2208 not 'Select...' AND f2143 not 'Select...')] [ShowElement 20 in #o1f977ebf093a][HideElement 102 in #o1f977ebf093a] [/IfField] [HideColumn 39 in #o1f977ebf093a] [IfField #o1f977ebf093a-f2207 is 'Yes'] [ShowColumn 74,75,76,77,85,81,83,84,78,79,80 in #o1f977ebf093a] [FillField #o1f977ebf093a-f2131//f2364 with 'Transferring in at Higher Dose (higher doses)'] [FillField #o1f977ebf093a-f2131//f2402 with unchecked] [/IfField] [IfField #o1f977ebf093a-f2207 is 'Yes' AND f2828 contains "Semaglutide"] [ShowColumn 142 in #o1f977ebf093a] [/IfField] [IfField #o1f977ebf093a-f2207 is 'Yes' AND f2828 contains "Tirzepatide"] [ShowColumn 82 in #o1f977ebf093a] [/IfField] [IfField #o1f977ebf093a-f2207 is 'No'] [FillField #o1f977ebf093a-f2131//f2364 with 'Just Getting Started (starter doses)'] [FillField #o1f977ebf093a-f2131//f2402 with checked] [/IfField] [HideElement 24 in #o1f977ebf093a] [HideElement 47 in #o1f977ebf093a] [IfField f2229 is "Yes"][ShowElement 89,107,108 in #o1f977ebf093a][HideElement 88 in #o1f977ebf093a][/IfField] [IfField f2229 is "No"][ShowElement 91 in #o1f977ebf093a][HideElement 90 in #o1f977ebf093a][/IfField] [IfAnchor #side.yes][FillField f2229 with "Yes"][/IfAnchor] [IfAnchor #side.no][FillField f2229 with "No"][/IfAnchor] [Calc $medication=#o1f977ebf093a-f2828] [HideField f2208] [IfAnchor #dose.sema.025][FillField f2208 with 'Semaglutide .25mg'][/IfAnchor] [IfAnchor #dose.sema.05][FillField f2208 with 'Semaglutide .5mg'][/IfAnchor] [IfAnchor #dose.sema.1][FillField f2208 with 'Semaglutide 1mg'][/IfAnchor] [IfAnchor #dose.sema.15][FillField f2208 with 'Semaglutide 1.5mg'][/IfAnchor] [IfAnchor #dose.sema.2][FillField f2208 with 'Semaglutide 2mg'][/IfAnchor] [IfAnchor #dose.sema.25][FillField f2208 with 'Semaglutide 2.5mg'][/IfAnchor] [IfAnchor #dose.tirze.25][FillField f2208 with 'Tirzepatide 2.5mg'][/IfAnchor] [IfAnchor #dose.tirze.5][FillField f2208 with 'Tirzepatide 5mg'][/IfAnchor] [IfAnchor #dose.tirze.75][FillField f2208 with 'Tirzepatide 7.5mg'][/IfAnchor] [IfAnchor #dose.tirze.10][FillField f2208 with 'Tirzepatide 10mg'][/IfAnchor] [IfAnchor #dose.tirze.125][FillField f2208 with 'Tirzepatide 12.5mg'][/IfAnchor] [IfAnchor #dose.tirze.15][FillField f2208 with 'Tirzepatide 15mg'][/IfAnchor] [IfField f2828 contains "Semaglutide" AND f2208 is "Semaglutide .25mg"] [ShowElement 118 in #o1f977ebf093a][HideElement 117 in #o1f977ebf093a] [/IfField] [IfField f2828 contains "Semaglutide" AND f2208 is "Semaglutide .5mg"] [ShowElement 120 in #o1f977ebf093a][HideElement 119 in #o1f977ebf093a] [/IfField] [IfField f2828 contains "Semaglutide" AND f2208 is "Semaglutide 1mg"] [ShowElement 122 in #o1f977ebf093a][HideElement 121 in #o1f977ebf093a] [/IfField] [IfField f2828 contains "Semaglutide" AND f2208 is "Semaglutide 1.5mg"] [ShowElement 124 in #o1f977ebf093a][HideElement 123 in #o1f977ebf093a] [/IfField] [IfField f2828 contains "Semaglutide" AND f2208 is "Semaglutide 2mg"] [ShowElement 126 in #o1f977ebf093a][HideElement 125 in #o1f977ebf093a] [/IfField] [IfField f2828 contains "Semaglutide" AND f2208 is "Semaglutide 2.5mg"] [ShowElement 128 in #o1f977ebf093a][HideElement 127 in #o1f977ebf093a] [/IfField] [IfField f2828 contains "Tirzepatide" AND f2208 is "Tirzepatide 2.5mg"] [ShowElement 130 in #o1f977ebf093a][HideElement 129 in #o1f977ebf093a] [/IfField] [IfField f2828 contains "Tirzepatide" AND f2208 is "Tirzepatide 5mg"] [ShowElement 132 in #o1f977ebf093a][HideElement 131 in #o1f977ebf093a] [/IfField] [IfField f2828 contains "Tirzepatide" AND f2208 is "Tirzepatide 7.5mg"] [ShowElement 134 in #o1f977ebf093a][HideElement 133 in #o1f977ebf093a] [/IfField] [IfField f2828 contains "Tirzepatide" AND f2208 is "Tirzepatide 10mg"] [ShowElement 136 in #o1f977ebf093a][HideElement 135 in #o1f977ebf093a] [/IfField] [IfField f2828 contains "Tirzepatide" AND f2208 is "Tirzepatide 12.5mg"] [ShowElement 138 in #o1f977ebf093a][HideElement 137 in #o1f977ebf093a] [/IfField] [IfField f2828 contains "Tirzepatide" AND f2208 is "Tirzepatide 15mg"] [ShowElement 140 in #o1f977ebf093a][HideElement 139 in #o1f977ebf093a] [/IfField] [HideElement 36 in #o1f977ebf093a] [IfField f2143 is "I want to keep my medication and dose the same"] [ShowElement 96 in #o1f977ebf093a][HideElement 92 in #o1f977ebf093a] [/IfField] [IfField f2143 is "I Want to Change Medication"] [ShowElement 99 in #o1f977ebf093a][HideElement 95 in #o1f977ebf093a] [/IfField] [IfField f2143 is "Discuss Increasing Dosage Strength"] [ShowElement 98 in #o1f977ebf093a][HideElement 94 in #o1f977ebf093a] [/IfField] [IfField f2143 is "Discuss Decreasing Dosage Strength"] [ShowElement 97 in #o1f977ebf093a][HideElement 93 in #o1f977ebf093a] [/IfField] [IfAnchor #continue.same][FillField f2143 with "I want to keep my medication and dose the same"][/IfAnchor] [IfAnchor #continue.change][FillField f2143 with "I Want to Change Medication"][/IfAnchor] [IfAnchor #continue.more][FillField f2143 with "Discuss Increasing Dosage Strength"][/IfAnchor] [IfAnchor #continue.less][FillField f2143 with "Discuss Decreasing Dosage Strength"][/IfAnchor] [IfField f2828 contains 'not currently taking' OR f2207 is 'No'] [FillField f2229 with 'Select...'] [FillField f2142 with ''] [FillField f2208 with 'Select...'] [FillField f2143 with 'Select...'] [/IfField] [HideBlock #obe197630c214] [IfField #obe197630c214-f2385//unique_id not ''][Redirect https://patients.orderlymeds.com/signup-v6][/IfField] [Calc $bmimin=27] [Calc $started=#o1f977ebf093a-f2131//f2364] [IfField #o1f977ebf093a-f2131//f2364 is 'Transferring in at Higher Dose (higher doses)'][Calc $bmimin=19][/IfField] [IfField #o1f977ebf093a-f2131//f2364 not 'Transferring in at Higher Dose (higher doses)'][Calc $bmimin=27][/IfField] [Calc $bmi=''] [ShowAfter 1sec][Calc $dateofbirth=''][/ShowAfter] [Calc $eitheenyearsago=$today-568024668] [IfVar $dateofbirth > $eitheenyearsago AND $bmi > $bmimin][Calc f2131//f2372,$eligibility='Age less than 18'][/IfVar] [IfVar $bmi <= $bmimin AND $dateofbirth > $eitheenyearsago][Calc f2131//f2372,$eligibility='BMI less than 27 And Age less than 18'][/IfVar] [IfVar $bmi <= $bmimin AND $dateofbirth < $eitheenyearsago][Calc f2131//f2372,$eligibility='BMI less than 27'][/IfVar] [IfVar $bmi > $bmimin AND $dateofbirth < $eitheenyearsago][Calc f2131//f2372,$eligibility=''][/IfVar] [IfField f2131//f2372 not ''][FillField f2131//f2162 with 'Not Eligible'][/IfField] [IfField f2131//f2372 is ''][FillField f2131//f2162 with 'Select...'][/IfField] [IfField f2131//f2162 is 'Select...'][FillField f2131//f2662 with checked][/IfField] [IfField f2131//f2162 is 'Not Eligible'][FillField f2131//f2662 with unchecked][/IfField]
Orderly Wellness

Current Medication

Have you taken any of the following GLP-1 medications in the past two months?
settings
Semaglutide (ie Ozempic® or Wegovy®)
settings
Semaglutide (ie Ozempic® or Wegovy®)
settings
Tirzepatide (ie Mounjaro® or Zepbound®)
settings
Tirzepatide (ie Mounjaro® or Zepbound®)
settings
I’m not currently taking a GLP-1 medication
settings
I’m not currently taking a GLP-1 medication
Have you taken any GLP-1 medications in the past two months?
settings
Yes
settings
Yes
settings
No
settings
No
Have you experienced any side effects from your current medication ?
settings
Yes
settings
Yes
settings
No
settings
No
settings
List any side effect you've had in the past.
settings
Which dose most closely matches your most recent dose of [Calc $medication display]?
settings
0.25 mg
settings
0.25 mg
settings
0.50 mg
settings
0.50 mg
settings
1 mg
settings
1 mg
settings
1.5 mg
settings
1.5 mg
settings
2 mg
settings
2 mg
settings
2.5 mg
settings
2.5 mg
settings
2.5 mg
settings
2.5 mg
settings
5 mg
settings
5 mg
settings
7.5 mg
settings
7.5 mg
settings
10 mg
settings
10 mg
settings
12.5 mg
settings
12.5 mg
settings
15 mg
settings
15 mg
settings
How would you like to continue your treatment ?
settings
Stay on the same dose or equivalent dose
settings
Stay on the same dose or equivalent dose
settings
I Want to Change Medication
settings
I Want to Change Medication
settings
Increase Dose
settings
Increase Dose
settings
Decrease dose
settings
Decrease dose
settings
settings
settings
settings
settings
settings
settings
settings
settings
settings
settings
settings
settings
settings
settings
settings
settings
[Today date_format=unix var=$today]
settings
SUBMIT
[bot_catcher]