Eligibility Quiz For My Teen

Answer a few questions so that our health care provider can respond with a personalized plan for your teen! (12-17 Yrs)

Please Provide Your Contact Info To Send The Quiz Result.

First Name *

Last Name *

Email *

Phone *

By providing your phone number and email, you agree to receive calls, text messages, and emails from Lean Dose Mobile regarding your medical consultation and weight loss plan. Your information will remain confidential and will not be shared with third parties without your permission. We promise no spam, and you can opt out at any time via the unsubscribe link in our emails. To stop receiving messages, reply with "STOP" at any time.

Please Enter Your Child's Birthdate

Where Do You Live In?

What Is Your Child's Main Goal?

How Often Does Your Teen Exercise?

Daily

A few times a week

Rarely

Never

Is Your Son Or Daughter Currently Using Any Weight Loss Medications?

Yes

What Medications And Dose Has Your Child Been On?

Does Your Teenager Have Any Of The Following Conditions? Check All That Apply.

Do you plan to pay with insurance?

Yes

What Medication Would You Prefer?