ProteusDx

Medicare GLP-1 Eligibility Screening

Complete this form to check your eligibility for the Medicare GLP-1 Bridge program and schedule your physician consultation.

Eligibility Quick Check

BMI ≥ 35

Eligible regardless of comorbidities

BMI ≥ 27

With at least one weight-related comorbidity

1Personal Information

First Name *

Last Name *

Email Address *

Phone Number *

Date of Birth

Preferred Contact Method

2Medicare Coverage

Medicare Type *

Both Traditional Medicare and Medicare Advantage with Part D qualify for the GLP-1 Bridge program.

3Clinical Information

Body Mass Index (BMI)

Don't know your BMI? Our team will calculate it during your consultation.

Weight-Related Comorbidities (select all that apply)

I am currently taking or have previously taken a GLP-1 medication

Current GI Symptoms (optional)

By submitting this form, you consent to being contacted by ProteusDx GI Wellness Clinic regarding the Medicare GLP-1 Bridge program. This form does not constitute a medical consultation or guarantee of eligibility. Final eligibility is determined by a licensed physician.