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Semaglutide or Tirzepatide Form Questionnaire

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Do you have a personal or family history of medullary thyroid carcinoma (MTC)?*
Do you have a history of Acute or Chronic Pancreatitis?*
Do you have a history of severe gastrointestinal disease including gastroparesis?*
Do you have a personal or family history of Multiple Endocrine neoplasia syndrome type 2 (MEN 2)?*
Do you have Diabetes Mellitus Type 1?*
Do you have a history of acute gallbladder disease?*
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