
🩺 Treatment Eligibility Screening
Servicing only: TX, UT, CO, AR, AK, OK and TN. To determine your eligibility for treatment, please answer the following questions with Yes or No: 1. Are you 18 years of age or older? 2. Is your BMI greater than 25? 3. Are you currently pregnant or breastfeeding? 4. Do you have Type 1 or Type 2 diabetes? 5. Do you have any known heart or kidney conditions? 6. Have you experienced issues with your gallbladder or pancreas? 7. Have you been diagnosed with gastroparesis? 8. Are you immunocompromised? 9. Do you have a personal history of medullary thyroid cancer (MTC)? 10. Have you been diagnosed with Multiple Endocrine Neoplasia Syndrome Type 2 (MEN 2)? ✅ If you answered “No” to all questions, you are eligible to proceed. A full medical review will be completed prior to starting treatment. You can now download the forms, fill them out, and submit them via email to: 📧 allurawellnessandbeauty@gmail.com Thank you for choosing Allura Wellness & Beauty!


















