Start your Journey

Step 1 of 25

Tell us where you currently live

Tell us where you currently live.(Required)

Alberta

Ontario

New Brunswick

Prince Edward Island

Other

Disclaimer

Unfortunately, Novowellness does not service your area at this time. We look forward to expanding our capabilities across Canada. Please check back soon.

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How long have you had concerns about your weight?

Understanding your health history and goals will help us make an accurate plan for your journey.

How long have you had concerns about your weight?(Required)

Less than 6 months

6 - 12 months

1 - 5 years

More than 5 years

How have you tried to lose weight in the past?

Select all that apply

How have you tried to lose weight in the past?

Surgery

Prescription weight loss medication

Laxatives or diurectics

Supplements or over-the-counter-products

Counselling

Therapy

Dieting

Exercise

Other

What surgeries have you tried, and what were the results?(Required)

Gastric Balloon

Laparoscopic Adjustable Gastric Band (Lap-band)

Sleeve Gastrectomi

Roux-en-Y Gastric Bypass

Other

Select all that apply

When did you have the procedure and what were the results?(Required)

Tell us more(Required)

Which weightloss medication(s) have you tried?

Select all that apply

Which weightloss medication(s) have you taken?(Required)

Ozempic

Contrave

Mounjaro

Orlistat Saxenda

Other

When did you take it? What was the dosage, effectiveness, and did you experience side effects?(Required)

What diets have you tried, and what were the results?

Select all that apply

What diets have you tried, and what were the results?(Required)

Atkins

Jenny Craig

Keto

Low Calorie

Ornish

Paleo

Weight Watchers

Other

When did you try this, and what were the results? How much weight did you lose?(Required)

Are you currently affected by an eating disorder?

Are you currently affected by an eating disorder?(Required)

No, but I have been in the past

Yes

Tell us more about your experience with eating disorders(Required)

How would you describe your diet in the past month?

Understanding your diet helps us choose the right treatment for you.

How would you describe your diet in the past month?(Required)

Very healthy

Meals are routinely prepared at home

Fairly healthy

Frequently prepare meals at home

Consuming fast food 1-2 times per month.

Unhealthy, rarely prepare meals at home and regularly consuming fast food

Do you currently exercise?

Do you currently exercise?(Required)

Yes

How many times per week?(Required)

Lets talk health history...Which of the following apply to you?

Lets talk health history...Do any of the following apply to you?

Chronic liver or Kidney disease

Diabetes

Sleep problems

Chest pain, fainting, palpitations, irregular heartbeat

Breathing issues

Gallbladder disease

Gastrointestinal problems

High blood pressure

High cholesterol

History of depression

History of pancreatitis

Personal or family history of medullary thyroid cancer

Personal or family history of multiple Endocrine Neoplasia Type 2

Opioid use or opioid agonist use (methadone/buprenorphine)

Schizophrenia or mania/bipolar disorder

Seizures or epilepsy

None of these apply

What was the extent of liver or kidney disease?(Required)

When was your last follow up for liver or kidney disease?(Required)

Were any specialists involved for liver or kidney disease? If so, who?(Required)

What type of Diabetes have you been diagnosed with?(Required)

Do you require insulin to manage your glucose levels?(Required)

Are you currently taking medication for Diabetes? If so, what medication and what dosage?(Required)

Has your blood glucose been stable? And for how long?(Required)

What was your Last A1C level?(Required)

Have you been diagnosed or suspected of obstructive sleep apnea?(Required)

Please describe, and for how long have you been affected with gastrointestinal problems?(Required)

What was your most recent BP reading?(Required)

Are you currently taking medication for High Blood Pressure? If so, what medication and what dosage?(Required)

What were your last lab readings for High cholesterol?(Required)

Are you currently taking medication for High cholesterol? If so, what medication and what dosage?(Required)

Have you been diagnosed with depression by a physician?(Required)

Are you currently taking medication for depression? If so, what medication and what dosage?(Required)

Do you have acute or chronic pancreatitis?(Required)

Are you currently taking medication for pancreatitis? If so, what medication and what dosage?(Required)

The following meds are known to induce weight gain: Insulin, glitazones, sulfonylureas, repaglinide, acarbose.

Ineligible for Semiglutide formulations but if interested, can trial alternatives.

Ineligible for Contrave but if interested, can trial alternatives.

Disclaimer

Our clients safety is important and our program does not work for everyone with certain health conditions. Some weight loss formulations are not appropriate for you based on your medical history. You may be eligible for trial alternative options. Patients may proceed but further information is required and a discussion with a Novowellness medical professional to determine suitability and to discuss risks vs. benefits of treatment.

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Click to acknowledge you have read the warnings and precautions above(Required)

Confirm

Warning and Precautions

Acute Pancreatitis

Has occurred in clinical trials. Discontinue use promptly if pancreatitis is suspected. Do not restart if pancreatitis is confirmed.

Acute Gallbladder Disease

Has occurred in clinical trials. If lelithiasis is suspected, gallbladder studies and clinical follow-up are indicated.

Hypoglycemia

Concomitant use with an or insulin may secretagogue or insulinmay increase the risk of hypoglycemia, including severe hypoglycemia. Reducing the dose of insulin secretagogue or insulin may be necessary. Inform all patients of the risk of hypoglycemia and educate them on the signs and symptoms of hypoglycemia.

Acute Kidney Injury

Has occurred. Monitor renal function when initiating or escalating doses of WEGOVY in patients reporting severe adverse gastrointestinal reactions or in those with renal impairment reporting severe adverse gastrointestinal reactions.

Hypersensitivity

Anaphylactic reactions and angioedema have been reported post marketing. Discontinue WEGOVY if suspected and promptly seek medical advice.

Diabetic Retinopathy Complications in Patients with Type 2 Diabetes

Has been reported in trials with semiglutide. Patients with a history of diabetic retinopathy should be monitored.

Heart Rate Increase

Monitor heart rate at regular intervals.

Suicidal Behavior and Ideation

Monitor for depression or suicidal thoughts. Discontinue WEGOVY if symptoms develop.

Click to acknowledge you have read the warnings and precautions above(Required)

Confirm

Do you take any prescriptions not yet mentioned or over the counter medications?

Knowing what you take will help us build your health profile.(Required)

Herbs

Supplements

Vitamins

Prescriptions

None of the above

Please list the names and dosages of what you take.(Required)

Have you had any other surgeries not yet mentioned?

Have you had any other surgeries not yet mentioned?(Required)

Yes

Please list any surgeries you have had and the dates they occured.(Required)

Are you currently pregnant, breastfeeding, or trying to get pregnant?

This includes being possibly pregnant or undergoing fertility treatments like IVF.

Are you currently pregnant, breastfeeding, or trying to get pregnant?(Required)

Yes

No, but I want to lose weight to improve my chances of getting pregnant in the future

Does your weight negatively affect your physical or mental health?

Does your weight negatively affect your physical or mental health?(Required)

Yes, a lot

Yes, somewhat

Maybe a little

Not at all

What are your weight loss goals?

What is your height and weight?

We’ll use this to determine your Body Mass Index (BMI) for diagnosis. Remember, BMI is a measure of size – not health.

Height ft(Required)

Please enter a number greater than or equal to 1.

In Feet

Height in

Please enter a number greater than or equal to 1.

In Inches

Weight(Required)

Please enter a number greater than or equal to 1.

In Pounds

What is your waistline?

Waistline(Required)

Please enter a number greater than or equal to 1.

In Inches

BMI Result

BMI Categories under 20 is not well suited for treatment with NovoWellness

Your BMI RESULT

Underweight = <18.5
Normal weight = 18.5–24.9
Overweight = 25–29.9
Obesity = BMI of 30 or greater

Your BMI RESULT

Underweight = <18.5
Normal weight = 18.5–24.9
Overweight = 25–29.9
Obesity = BMI of 30 or greater

Your current BMI is not well suited for treatment with NovoWellness. Please reach out to another healthcare provider, such as a family doctor or walk-in clinic, to review your weight management options.

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Do you have a family Dr?

Do you have a family Dr?(Required)

Yes

Please enter your Dr. Name and their Clinic Address.

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Do you already have a prescription?

Do you already have a prescription?(Required)

Yes

You will be able to upload your prescription once our account set up is complete

Upload Your Prescription

Max. file size: 256 MB.

Have you had blood work done in the last 6 months?

Have you had blood work done in the last 6 months?(Required)

Yes

Please upload your most recent results here.

Max. file size: 256 MB.

What was your most recent blood pressure reading?

Your blood pressure helps us determine if certain medications are safe for you.

What was your most recent blood pressure reading?(Required)

Normal or low (120/80 or lower)

Above normal (121/80 to 129/80)

High (130/81 to 139/89)

Higher (140/90 or higher)

I don’t know

A few final questions before we build your personalized treatment plan.

What's your name?(Required)

First Last

What's your date of birth?(Required)

Your date of birth needs to match your government issued ID.

Email Address(Required)

Password(Required)

Thank you for choosing NovoWellness! We look forward to being a part of your wellness journey. A clinician is working on assessing your submission responses and will be in touch soon.