Assessment - Nova RX

I want to(Required)

Improve my general physical health

Improve another health conditions

Increase confidence about my appearance

Increase energy for activities I enjoy

I have another goal not listed above

Your Goal(Required)

To verify eligibility, please, tell us your date of birth(Required)

MM slash DD slash YYYY

Consent(Required)

By clicking 'Next', you agree that Nova RX may use your responses to personalize your experience and other purposes as described in our Privacy Policy. Responses prior to account creation will not be used as part of your medical assessment.

Doctor will get in touch with you verify eligibility for selected product. If not prescribed, you will get full refund.

What was your sex assigned at birth(Required)

Men

Women

Full Name(Required)

First Last

This field is hidden when viewing the form

Full Name

Phone(Required)

Email(Required)

Are you currently pregnant, breastfeeding, or planning to become pregnant soon?(Required)

Yes

Have you ever tried Semaglutide or similar weight loss injections (GLP-1)?(Required)

Yes, and I’d like to continue

No, but I’m open to trying

No, and I’m not comfortable with injections

Would you say you’re looking to lose at least 20 pounds or more?(Required)

Yes, I’ve been trying to lose that much or more

I want to lose a few pounds only

I’m not actively trying to lose weight

Do you have any history of thyroid cancer or a condition called MEN 2?(Required)

Yes

Have you ever had pancreatitis or any gallbladder issues?*(Required)

Yes

Do you take insulin or have type 1 diabetes?(Required)

Yes

Not Sure

Are you taking any other weight loss medications right now?(Required)

Yes, but I’m open to switching

Yes, and I plan to continue with them

Do you have any major liver or kidney conditions?*(Required)

Yes

Not Sure

What is your height?(Required)

What is your weight?(Required)

Do you have an allergy to GLP-1 agonist medications?(Required)

Yes

Examples include tirzepatide (Zepbound/Mounjaro), liraglutide (Saxenda/Victoza), semaglutide (Wegovy/Ozempic), and dulaglutide (Trulicity).

Do you currently take any of the following medications?*(Required)

A GLP-1 agonist such as (but not limited to) semaglutide (Wegovy/Ozempic), liraglutide (Saxenda/Victoza),

Dulaglutide (Trulicity), tirzepatide (Zepbound/Mounjaro)

Sulfonylureas such as (but not limited to) glipizide (Glucotrol), glimepiride (Amaryl)

Insulin

Warfarin (also called Jantoven or Coumadin) - a blood thinner that usually requires regular lab testing

Meglitinides such as repaglinide or nateglinide

Diuretics such as (but not limited to) furosemide (Lasix), bumetanide (Bumex) Hydrochlorothiazide/HCTZ

Selective Serotonin Reuptake Inhibitor (SSRI) such as (but not limited to) citalopram (Celexa), fluoxetine (Prozac), escitalopram (Lexapro)

Monoamine Oxidase Inhibitor (MAOl) such as (but not limited to) phenelzine (Nardil), selegiline (Emsam)

None of the above

Congrat's Your Pre-Qualified!

After checkout, one of our licensed doctors will personally review your assessment within a few hours to ensure the treatment is right for you. Please allow 3–5 days for us to process your case and ship your medication. 100% refundable if you’re not approved

Thank you for completing the assessment.

At this time, it looks like you may not qualify for our Semaglutide program. We truly appreciate your interest, and your health remains our top priority. If your situation changes, we’d be happy to reassess in the future.