0
    0
    Your Cart
    Your cart is empty
      Calculate Shipping
      Apply Coupon
      Available Coupons
      50off Get $50.00 off

        New Patient Form

        This field is for validation purposes and should be left unchanged.

        Patient Information:

        Name:(Required)
        Date of Birth:(Required)
        Would you like to receive text messages from Sands Weight Loss and Wellness regarding appointment information, weight management, and medication delivery?(Required)
        Text message and data rates may apply depending on your mobile carrier and phone.
        Address:(Required)
        Please enter a number from 3 to 8.
        Please enter a number from 0 to 11.
        Please check if you have a history of any of the following:
        When did you last see your PCP?(Required)
        Do we have permission to reach out to your PCP?(Required)
        IF YOU ARE CURRENTLY TAKING SEMAGLUTIDE OR TIRZEPATIDE OR HAVE TAKEN IT WITHIN THE LAST 30 DAYS, PLEASE UPLOAD AN IMAGE OF YOUR PRESCRIPTION IN ORDER TO AVOID STARTING OVER ON THE LOWEST DOSE
        Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 256 MB.

        Hours

        Monday-Friday 9am – 5pm
        Saturday 9am – 1pm

        Address

        2300 Lakeview Parkway, 7th Floor Alpharetta, GA 30009

        Scroll to Top