Instavial.com - Weight loss, better sex, more energy, fuller hair, fertility, improved skin and more

Your health profile

Please answer the following questions so we can qualify you for treatment.

Height (feet)*

Height (inches)*

Current weight (lbs)*

Goal weight (lbs)*

Biological sex*

Date of birth*

Do any of these apply to you?*

Select all that apply

End-stage kidney disease (on or about to be on dialysis)

End-stage liver disease (cirrhosis)

Current suicidal thoughts and/or prior suicidal attempt

Cancer (active diagnosis, active treatment, or in remission/cancer-free for less than 5 years — does not apply to non-melanoma skin cancer cured via simple excision)

Severe gastrointestinal condition (gastroparesis, blockage, inflammatory bowel disease)

Current diagnosis of or treatment for alcohol, opioid, or substance use disorder/dependence

None of the above

Within the last 3 months, have you taken opiate pain medications and/or opiate-based street drugs?*

Have you had prior weight loss surgeries?*

Do you currently take any prescription medications?*

What is your blood pressure range?*

What is your average resting heart rate?*