The intake form, question by question

About you and your goals

Height, weight and your goal

Used to work out BMI and to set realistic goals. The American College of Physicians lists weight goals and personal values as part of the discussion.

Your weight history and what you have tried

Gives your clinician the full picture. It also shows whether other approaches have been tried and what happened.

Your eating, activity and sleep habits

These shape the plan alongside the medicine. A 2025 advisory from four U.S. nutrition and obesity societies stresses healthful eating, activity and resistance training.

Your medical history

Thyroid cancer, or a family history of medullary thyroid carcinoma or MEN 2

The Wegovy and Zepbound labels carry a boxed warning about thyroid C-cell tumors in rodents and list this history as a reason not to use the medicine.

Pancreatitis or gallbladder disease

Both labels warn about acute pancreatitis and acute gallbladder disease.

Kidney disease, or recent vomiting and dehydration

Both labels warn about acute kidney injury from fluid loss.

Type 2 diabetes, eye problems from diabetes, and diabetes medicines

Labels warn about low blood sugar, especially with insulin or sulfonylureas, and about diabetic retinopathy complications.

Stomach or bowel conditions

Both labels warn about severe digestive side effects.

Heart disease and blood pressure

These can count as weight-related conditions. The American College of Physicians also notes that one other weight-loss medicine, phentermine-topiramate, is not for people with cardiovascular disease.

Mental health, eating disorders and substance use

The 2025 advisory calls for screening and care around eating disorders, mental health, substance use and sleep as part of weight-loss treatment. The American College of Physicians lists suicidal thoughts as a warning for naltrexone-bupropion.

Medicines, supplements and allergies

Everything you take, including over-the-counter products and supplements

Interactions and dose changes depend on the full list. The Wegovy label advises against using it together with other semaglutide or GLP-1 products.

Birth control pills

The Zepbound label says tirzepatide can make oral hormonal contraceptives less effective, and advises a non-oral method or a barrier method for 4 weeks after starting and after each dose increase.

Serious allergic reactions

A serious allergy to the medicine or its ingredients is a reason not to use it.

Pregnancy and breastfeeding

Pregnant, planning to be, or breastfeeding

The labels say weight loss offers no benefit in pregnancy and the medicine may harm the baby. Wegovy is stopped when pregnancy is recognized, and the label advises stopping at least 2 months before a planned pregnancy. For the Wegovy tablets, the label does not recommend breastfeeding.

Surgery and sedation

Any upcoming surgery, endoscopy or procedure with sedation

Both labels warn about food or liquid entering the lungs during general anesthesia or deep sedation. Tell the anesthesia team you take the medicine.

The practical questions

Insurance, pharmacy and where you live

Used for coverage checks, sending the prescription, and confirming the clinician can treat you where you live.

Who else treats you

Lets your regular clinician stay informed. A 2025 study found that only about 8% of patients in a large primary-care database had compounded GLP-1 use documented, while surveys suggested about 23% were getting them, so care outside your regular clinician can go unrecorded.

Questions to ask

• Is there anything in my history that changes which medicine suits me?
• Do any of my current medicines need to change?
• Should I get blood tests before I start?

What is still unknown

• Forms differ. Yours may ask more, or less, than this list.
• The Atlas does not know what any particular service asks.