Please fill out the health form below. This will need to be completely filled out and submitted before we send the HCG.

 

 

HCG Diet Questionnaire

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How did you find out about HCGDiettips.com?

I understand that HCG is a prescription medication and that final approval is dependent on the information submitted on my health questionnaire and a live consultation with with one of our affiliated licensed physicians. If approved, I understand that the medication I am prescribed is for my personal use only, and that the health questionnaire I submitted is truthful and pertains to me personally.
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Before starting any diet or exercise program, you must consult your primary physician. You will receive a phone call from our doctor. He is a consulting physician working in concert with your primary physician on your weight loss program. Please fax any recent physical/records to (800) 905-7112.


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