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Let's get started with your weight loss Journey! Please fill out the following form.

Date of birth
Month
Day
Year
Is your BMI >= 27
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List current height and weight _____________________
Are you suffering from High blood pressure, Diabetes, sleep apnea, high cholesterol, cardiovascular disease?
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Yes
If Yes list, __________________________
LEGACY WELLNESS
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Legacy Wellness offers a fully online, physician-supervised weight loss program featuring weekly injections of GLP-1 medications (like Semaglutide or Tirzepatide), home delivery, ongoing clinical support, nutrition & fitness guidance, and virtual urgent care visits.

ejp-legacywellness@outlook.com

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704-561-1324

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