Get Started — MyRxProvider

Let's get you started.

Your answers are confidential and reviewed only by your care team — never your employer.

Employer access code — optional

Have a code from your HR team or benefits portal? Enter it to unlock your workplace member rate. No code? You can still continue.

Please enter your employer access code.

First name

Required.

Last name

Required.

Date of birth

You must be 18 or older to use MyRxProvider.

Email

Please enter a valid email.

Mobile phone

Please enter a valid phone number.

State of residence

You must be physically located in this state during telehealth visits.

Please select your state.

Sex assigned at birth

Female Male

Please select an option.

Your starting point.

This helps your provider assess clinical eligibility for GLP-1 therapy.

Height

Please enter your height.

Current weight (lbs)

Please enter your weight.

Your BMI: —

Goal weight (lbs) — optional

Have you tried to lose weight before through diet or exercise?

Yes No

Please select an option.

Safety first.

Some conditions mean GLP-1 medication isn't safe. Please answer honestly — your provider depends on it.

Do any of the following apply to you?

Personal or family history of medullary thyroid carcinoma (MTC)A rare type of thyroid cancer Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) History of pancreatitis Gastroparesis or severe digestive/stomach-emptying disorder Currently pregnant, breastfeeding, or trying to become pregnant Type 1 diabetes or history of diabetic ketoacidosis Active eating disorder (e.g., anorexia, bulimia) Prior serious allergic reaction to semaglutide or tirzepatide None of these apply to me

Please select all that apply, or "None of these apply to me."

Health history.

Check anything you've been diagnosed with or treated for.

Anything else your provider should know? — optional

Medications & allergies.

This prevents dangerous drug interactions.

Are you currently taking any prescription medications?

Yes No

Please select an option.

Have you used a GLP-1 medication before (Ozempic, Wegovy, Mounjaro, Zepbound, compounded semaglutide/tirzepatide)?

Yes — I'm taking one now Yes — in the past, not currently No — never

Please select an option.

Do you take insulin or a sulfonylurea (e.g., glipizide, glyburide)?

Yes No

Please select an option.

Drug allergies

Please list allergies or type "None".

Review & consent.

Please open and review each document. Your care can't begin without informed consent.

I have read and agree to the Telehealth Informed ConsentHow telehealth care works, its benefits and limitations I have read and agree to the GLP-1 Medication Informed ConsentRisks, side effects, boxed warning, and compounded-drug disclosures I acknowledge the Privacy Policy & Notice of Privacy PracticesHow your health information is used and protected (HIPAA) I agree to the Terms of Service I certify my answers are true and completeProviders rely on this information to prescribe safely

Please review and check all consents to continue.

By continuing you consent to receive communications about your care by email and SMS. Message and data rates may apply. You can opt out of SMS at any time.

Almost done.

Confirm your details, then submit for provider review.

What happens next: a licensed provider in your state reviews your intake, usually within 24–48 hours. They may message you with follow-up questions or schedule a video visit before making any prescribing decision.

✓

Intake submitted.

Thanks, ! Your intake is in the queue for provider review. We'll email you at within 24–48 hours.

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