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Eligibility Assessment

Additional Questions

Leaner AVO follows strict clinical protocols to ensure patient safety.

These questions are designed to help personalise your weight loss journey.

Your responses allow our doctors to determine your eligibility for medical programs. Please ensure all information is accurate and complete.

  1. Do you have a preferred treatment in mind?*

Single choice
Mounjaro (Tirzepatide)
Ozempic or Wegovy (Semaglutide)
Tablet-Form Medication (e.g. Contrave or Duromine)
Lifestyle interventions (Diet and exercise plan) only
I don't have a preference

  1. Do you take any medications?

  1. Have you previously had weight loss surgery?*

Single choice
Yes
No

4. Do you have any allergies?*

Single choice
Yes
No

4a. Please list all allergies and reaction you get

  1. What is important for you in your weight loss journey?

Multi choice

6. What is your ideal goal weight that you would like to reach?

  1. What do you think has contributed most to your weight gain?

8. Please describe your diet - what you would eat on a typical day

9. How much exercise do you typically do each week?*

Single choice
Less than 2.5 hours
2.5 - 5 hours
More than 5 hours
I don’t exercise
Other

10. Do you have any long-term injuries or conditions with your ability to exercise?

11. Is there anything else you would like to share with your clinician?

Patient Note: This is a pre-screening assessment only and does not constitute medical advice or a formal consultation. Eligibility is subject to physician review. Submitting this form acknowledges consent to our clinical assessment protocol.

By submitting this form, you acknowledge that your health data is collected for clinical review in accordance with our privacy policy and Australian healthcare regulations. Your data is processed securely via our medical portal.

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