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Step 1 of 7 — Program Selection
Step 1 of 7

What's your goal?

Select the program that best fits your needs. Your physician will tailor the treatment plan to you.

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🩺Licensed Physicians
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❌No Insurance Needed
Step 2 of 7

Your height & weight

We use this to calculate your BMI and assess eligibility. GLP-1 therapy requires BMI ≥ 27.

Step 3 of 7

Medical History

Answer honestly — your physician uses this to prescribe safely. Check all that apply in each group.

⚠️ GLP-1 therapy is contraindicated if you have a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Your physician will evaluate all responses.
Health Questions 1 — Do any of these apply to you?
These conditions may affect eligibility. Check all that apply.
Health Questions 2 — Do any of these apply to you?
Check all that apply — these help your physician tailor your care plan.
Health Questions 3 — Do any of these apply to you?
Check all that apply.
Health Questions 4 — Do any of these apply to you?
Check all that apply.
Are you currently pregnant, breastfeeding, or planning to become pregnant? *
Step 4 of 7

Current Medications

This helps your physician check for drug interactions. Include all prescription, OTC, and supplement medications.

Do you currently take any prescription medications? *
Have you taken medication for weight loss in the past 4 weeks?
Have you ever tried a structured weight loss program?
What is your blood pressure range?
What is your average resting heart rate?
Step 5 of 7

Symptoms & Goals

Help your physician understand your situation and personalize your treatment plan.

Current symptoms (check all that apply):
How active are you currently?
What matters most to you? *
Helps your physician recommend the best medication option for you.
Delivery format preference:
Personal goals — select all you're interested in:
Your GLP-1 medication is personalized to your specific needs.
Have you had hormone levels tested recently?
Do you have any further information you'd like your physician to know?
Step 6 of 7

Informed Consent

Please read and acknowledge each item before submitting your assessment to an independent licensed physician.

📋 What happens next: An independent licensed physician reviews your submission within 24 hours. If approved, your prescription is sent to a licensed compounding pharmacy. You'll receive email/SMS updates. ProviaRx does NOT prescribe — all decisions are made exclusively by independent physicians.
⚠️ Compounded Medication Notice: These medications are NOT FDA-approved. They are produced in FDA-regulated compounding facilities but have not been evaluated by FDA for safety, efficacy, or quality. Your physician will discuss all risks.
By submitting, you agree to ProviaRx's Terms & Conditions and Privacy Policy. ProviaRx is a technology platform only. All prescribing decisions are made by independent licensed physicians. This assessment does not create a doctor-patient relationship.
Step 7 of 7 — Final Step

Almost done — your contact details.

Collected last so your physician has your full health picture. HIPAA-encrypted.

⚠️ Legal Notice: All information must be accurate and truthful. Providing false information — including a false name, date of birth, or medical history — to obtain prescription medication is a federal offense under 21 U.S.C. § 843 and may result in criminal prosecution. Your identity may be verified by the physician prior to prescribing.
We'll send your approval status here
For prescription status updates via SMS
Must match your government-issued ID — used for physician verification
Required for accurate medication dosing. If intersex, your physician will discuss the appropriate protocol with you directly.
Available in 49 states (not North Dakota)
🔒 Your information is protected under HIPAA. Only your assigned independent physician will access it.
✓

Assessment Submitted!

An independent licensed physician will review your assessment within 24 hours. Check your inbox for your approval status, payment link, and shipping details.

What Happens Next

1
Physician reviews your medical history (within 24 hrs)
2
Approval email with personalized treatment plan sent to you
3
Complete payment to activate your subscription (no charge today)
4
Licensed pharmacy ships your medication in discreet packaging (3–5 days)
5
Patient portal access for ongoing care, messaging & AI support
<24hr
Physician review
3–5
Days to ship
$0
Due today — pay only after approval

Questions? Email [email protected] or use the live chat on our site.

🔒HIPAA Secured
🩺Independent Physicians
📦Discreet Shipping