770.649.0094
4343 Shallowford Rd #150, Marietta,GA 30062
VIRTUAL CONSULT
TEXT US
Home Page
About Dr. Kelley
Weight Loss
Weight Management program GLP1
Lean Body Program
Wellness
Bioidentical Hormones
IV Therapy
Liquivida Drip Glossary
GI Health
Oshot l Feminine Rejuv
O Shot
Vampire winglift
V fit Gold
Procedures
Xeomin Wrinkle relaxer
Botox
Sculptra-CWA Precise Sculpt
Wrinkle Fillers- Contour and Rejuvenate
Radiesse-Contour, Lift and Tighten
Microneedling for beautiful and healthy skin
Exilis Elite Facial Skin Tightening
PRP Hair Therapy
Pre and Post PRP hair Instructions
PRP Injections
O Shot
Testimonials
Pricing
770.649.0094
4343 Shallowford Rd #150, Marietta,GA 30062
VIRTUAL CONSULT
TEXT US
Home Page
About Dr. Kelley
Weight Loss
Weight Management program GLP1
Lean Body Program
Wellness
Bioidentical Hormones
IV Therapy
Liquivida Drip Glossary
GI Health
Oshot l Feminine Rejuv
O Shot
Vampire winglift
V fit Gold
Procedures
Xeomin Wrinkle relaxer
Botox
Sculptra-CWA Precise Sculpt
Wrinkle Fillers- Contour and Rejuvenate
Radiesse-Contour, Lift and Tighten
Microneedling for beautiful and healthy skin
Exilis Elite Facial Skin Tightening
PRP Hair Therapy
Pre and Post PRP hair Instructions
PRP Injections
O Shot
Testimonials
Pricing
Home Page
About Dr. Kelley
Weight Loss
Weight Management program GLP1
Lean Body Program
Wellness
Bioidentical Hormones
IV Therapy
Liquivida Drip Glossary
GI Health
Oshot l Feminine Rejuv
O Shot
Vampire winglift
V fit Gold
Procedures
Xeomin Wrinkle relaxer
Botox
Sculptra-CWA Precise Sculpt
Wrinkle Fillers- Contour and Rejuvenate
Radiesse-Contour, Lift and Tighten
Microneedling for beautiful and healthy skin
Exilis Elite Facial Skin Tightening
PRP Hair Therapy
Pre and Post PRP hair Instructions
PRP Injections
O Shot
Testimonials
Pricing
Weight Loss History
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Weight Loss History
General Information
Name:
Date of Birth:
Phone number
Email
Can we text you?
Yes
No
What is your height and weight?
List all your medications
List all your supplements
Please list any medical problems you may have, for example, diabetes or hypertension
Do you have any allergies to medications?
Yes
No
If yes, what are they?
Do you have any other allergies?
Yes
No
Please list any surgeries you have had in the past
Do you have any medical reasons for exercise limitations?
If yes, what are they?
How long have you struggled with your weight?
*
What is your overall goal for weight loss?
Please list anything you have tried for weight loss in the past.
How many times a week do you exercise?
What type of exercise?
Do you have a Primary Care doctor?
*
Do you eat breakfast? Are you hungry in the morning?
Yes
No
If you eat breakfast, what is a typical breakfast for you?
If you eat lunch, what is a typical lunch for you?
What is a typical dinner for you?
What has made it difficult for you to lose weight in the past?
Do you feel that you are an emotional eater?
Yes
No
If you have food cravings, please list them here.
Have you had lab testing in the past 6 months?
Yes
No
