Board-Certified PhysiciansMedical Weight Loss ProgramState-Licensed U.S. Compounding PharmaciesHIPAA CompliantFDA-Approved GLP-1 MedicationsTelehealth Convenience

Application

Five Minutes. Read by a Human.

Every application is reviewed personally within 24 hours. If you’re accepted and decide to proceed, the $199 program fee is charged and your intake visit is scheduled. If you’re not a fit, we’ll tell you why — before anything is charged.

Start Application

Before You Start

What to Have Ready.

About five minutes. Having this at hand will keep it moving.

Basic contact info

Name, email, phone, and the U.S. state you live in. Our affiliated physician network is licensed across all 50 states.

Health background

Major medical conditions, current medications, and any relevant family history (especially thyroid cancer, MEN2, or pancreatitis). Your physician will ask about this again during the intake consult.

Your goals

Roughly what you’re hoping to accomplish and what you’ve tried in the past. Plain language is fine.

Five unhurried minutes

The form is short but the questions are real. Best completed when you’re not distracted.

Start Your Application.

A member of our team reads every submission within 24 hours. If we don’t think the program is right for you, we’ll tell you honestly — before any payment.

First name *

Last name *

Email *

Phone *

Date of birth *

State of residence *

Treatments you’re interested in *

Do you have a personal or family history of medullary thyroid cancer (MTC) or Multiple Endocrine Neoplasia type 2 (MEN2)? *

Have you ever been diagnosed with pancreatitis? *

Are you pregnant, breastfeeding, or actively trying to conceive? *

I agree that the phone number and e-mail I am providing may be used to contact me by AFJA Enterprise LLC (including with auto-dialed/auto-selected and prerecorded calls and AI-generated communications, as well as text/SMS messages) and email with information and offers regarding my inquiry. Message and data rates apply, and my consent to such contact/marketing is not required for purchase or use of services.

By submitting, you confirm that you are 18 years of age or older and consent to be contacted about your eligibility for the AFJA 6-Week Weight Loss Program. Treatment decisions are made solely by a licensed prescribing clinician exercising independent medical judgment. Completing this form does not guarantee qualification for treatment. Individual results may vary. Compounded medications are not FDA-approved but are prepared by licensed compounding pharmacies. All information is HIPAA-protected. AFJA does not share, sell, or market based on your data.

After You Apply

What Happens, and When.

Within 24 hours

A member of our team reads your application personally. You hear back by email or phone, whether accepted or not. Declines come with a brief honest explanation.

Within 3 business days

If accepted and you choose to proceed, the $199 program fee is charged and your intake visit is scheduled with a board-certified physician in your state.

Within ~2 weeks

Intake consult done, labs collected and returned, protocol designed, first medication shipment on the way. You begin the 6-week program.

One more thing

Applying Is Not a Commitment.

The application is free. The $199 is only charged after you’re accepted AND choose to proceed. You’re choosing whether to keep going at every step.

Start the Application