GLP-1 Telehealth Intake Forms: What the FDA Labels Say

A GLP-1 telehealth intake form should screen for what the FDA labels for Wegovy (semaglutide) and Zepbound (tirzepatide) flag: a personal or family history of medullary thyroid carcinoma (MTC) or MEN 2, a past serious allergic reaction to the drug, other GLP-1 use, pancreatitis, gallbladder disease, diabetes medicines such as insulin, and pregnancy or plans for one, plus weight and weight-related conditions (Wegovy label; Zepbound label). The form only collects answers; the prescribing clinician decides who is eligible. Every answer is health information, so Curve Forms from Curve Compliance hosts the intake under the BAA Curve signs on every plan and sends ad platforms a neutral form event, never the answers.

Book a demo. See how a guided GLP-1 intake would run in Curve Forms, or have Curve's team review your intake funnel with you and what each step sends to ad platforms. Book a Curve Forms demo.

What the labels say about weight loss

The Wegovy label says Wegovy injection is indicated, with a reduced calorie diet and increased physical activity, "to reduce excess body weight and maintain weight reduction long term in" adults and pediatric patients aged 12 years and older with obesity, and in "adults with overweight in the presence of at least one weight-related comorbid condition." Wegovy tablets carry the same weight indication for adults only.

The Zepbound label says Zepbound is indicated "to reduce excess body weight and maintain weight reduction long term in adults with obesity or adults with overweight in the presence of at least one weight-related comorbid condition" and "to treat moderate to severe obstructive sleep apnea (OSA) in adults with obesity." It adds: "The safety and effectiveness of ZEPBOUND have not been established in pediatric patients."

Neither indication states a BMI number. The numbers describe who the weight trials enrolled. Wegovy's Study 2 enrolled "patients with obesity (BMI greater than or equal to 30 kg/m2) or with overweight (BMI 27 to 29.9 kg/m2) and at least one weight-related comorbid condition" (Wegovy label, section 14.2). Zepbound's Study 1 enrolled "adult patients with obesity (BMI ≥30 kg/m2), or with overweight (BMI 27 to <30 kg/m2) and at least one weight-related comorbid condition" (Zepbound label, section 14.1). That is why GLP-1 intake forms commonly ask for height, weight and weight-related conditions.

The screening questions the labels point to

Both labels open with a boxed warning headed "WARNING: RISK OF THYROID C-CELL TUMORS." Each drug "is contraindicated in patients with a personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)" (Wegovy; Zepbound). The table maps that and the other label sections intake forms commonly ask about.

Label topic	What the label says	The form asks about	Where
Thyroid C-cell tumors	Contraindicated with "a personal or family history of MTC" or MEN 2	Medullary thyroid cancer in you or your family; MEN 2	Boxed warning, 4 (Wegovy, Zepbound)
Serious allergic reactions	Contraindicated after "a prior serious hypersensitivity reaction to semaglutide" (Wegovy) or with "Known serious hypersensitivity to tirzepatide" (Zepbound)	Allergies; past reactions to a GLP-1 medicine	4 (Wegovy, Zepbound)
Other GLP-1 medicines	Use "with any other GLP-1 receptor agonist is not recommended" (Wegovy); Zepbound says the same	Current or past GLP-1 or tirzepatide use	1 (Wegovy, Zepbound)
Acute pancreatitis	"If pancreatitis is suspected, discontinue" the drug	Past pancreatitis	Wegovy 5.2; Zepbound 5.5
Gallbladder disease	Wegovy "is associated with an increased occurrence of cholelithiasis and cholecystitis"	Gallstones or gallbladder problems	Wegovy 5.3; Zepbound 5.4
Diabetes	Low blood sugar risk rises with "insulin or an insulin secretagogue"; "Patients with a history of diabetic retinopathy should be monitored"	Diabetes, insulin or sulfonylurea use, diabetic eye disease	Wegovy 5.4, 5.8; Zepbound 5.7, 5.8
Severe gastroparesis	The drug is "not recommended in patients with severe gastroparesis"	Gastroparesis (slow stomach emptying)	Wegovy 5.6; Zepbound 5.2
Planned surgery	Patients should tell providers "prior to any planned surgeries or procedures"	Upcoming surgery or sedation	Wegovy 5.10; Zepbound 5.9
Pregnancy	Wegovy: stop "at least 2 months before they plan to become pregnant"; Zepbound: "discontinue ZEPBOUND when a pregnancy is recognized"	Pregnancy, plans to conceive, breastfeeding	Wegovy 8.1 to 8.3; Zepbound 8.1
Birth control pills	Zepbound users of oral hormonal contraceptives should be advised "to switch to a non-oral contraceptive method, or add a barrier method" for 4 weeks after starting and after each dose increase	Birth control pill use	Zepbound 7.2, 8.3

The labels are written for prescribers, not forms. A form answer is not a decision; a licensed clinician reads the answers and makes the call, and also chooses which questions the form asks.

Every answer on a GLP-1 intake form is health information

For a HIPAA covered entity, HHS's bulletin on online tracking says tracking technologies "might collect an individual's email address, or reason for seeking health care typed or selected by an individual, when the individual visits a regulated entity's webpage and makes an appointment with a health care provider," and that then "the regulated entity is disclosing PHI to the tracking technology vendor, and thus the HIPAA Rules apply." Regulated entities "must ensure that all tracking technology vendors have signed a BAA and that there is an applicable permission prior to a disclosure of PHI" (HHS bulletin). A June 20, 2024 court order vacated a different part, about IP addresses on public pages (the bulletin, annotated).

If your program is cash-pay, start with does HIPAA apply to cash-pay telehealth. Either way, the FTC says the FTC Act's obligations "apply to HIPAA-covered entities and business associates, as well as to companies that collect, use, or share health information that aren't required to comply with HIPAA," and that "health information" "includes more than treatments and diagnoses. Rather, it's anything that conveys information or enables an inference about a consumer's health" (FTC guidance). Weight, thyroid history and pregnancy answers fit that description. For which rules apply to your program, talk to your counsel.

What the FTC alleged about a telehealth intake flow

On July 29, 2026, the FTC, joined by Utah and California, sued Hims & Hers, a telehealth company whose offerings, the complaint says, include "treatments for sexual health, hair loss, skin, mental health, and weight loss" (FTC press release; complaint). Consumers "must fill out an online intake form for review by a medical provider before obtaining treatment," the FTC says, and the complaint describes that Intake Flow as "approximately 5 to 15 questions regarding their treatment interests and goals," account sign-up, and "a medical assessment consisting of between 25 and 50 questions regarding the consumer's medical history."

The complaint alleges that a "Purchase" Event fired "whenever a consumer submitted an Intake Flow," and that the version Hims shared with Meta through the Meta Pixel and Conversions API carried the consumer's identifiers, "such as their email and IP addresses," combined with "information about the specific medical treatment Hims said the consumer was attempting to purchase by submitting an Intake Flow" (complaint, paragraphs 70 to 73). The complaint's examples name erectile dysfunction, premature ejaculation and mental health. These are allegations; the FTC lists the case as pending (case page).

Plan around that theory: a standard submit event can carry who submitted and what they sought. Keep answers and treatment names out of ad events; see where the compliance risk sits in a GLP-1 quiz funnel.

Putting the questions in order

Ask the questions that can end the flow first: state, age, and the screening questions your clinician sets. Ask for contact details once the person is invested, then consent, then send them to booking or checkout. Curve's companion guides cover what a telehealth intake form should ask, eligibility screening and building the multi-step funnel. To find the question that loses people, measure each step: where GLP-1 quiz funnels lose patients.

How Curve Forms helps

Curve Forms builds this intake as a guided flow, one step per card with a progress bar, with radio, multi-select, date, number and file upload fields. Logic shows or hides a follow-up based on earlier answers and routes people to different outcomes. Screening outcomes screen people out by age (date of birth rules), service area (a state answer) or insurance, each with its own end screen, and screened-out submissions send no conversion to ad platforms, so the platforms learn from eligible leads. Separate checkboxes collect privacy consent and marketing consent, and a redirect after submit can take people to your booking or checkout page.

Each form is hosted by Curve under the BAA Curve signs on every plan, so submissions never pass through a third-party form tool. Every lead lands in the Leads inbox with its answers, UTMs and ad click ID, and every view or export is logged. Form events (form started, step progress, form submission completed, lead qualified, lead converted) reach Meta, Google Ads and your other destinations server-side through your event mappings. Form answers, page titles and free text are never sent, step labels are stripped from step events, and contact identifiers are off by default on Meta, Google Ads and TikTok. The step-by-step funnel shows where people drop off. See also Curve for weight loss clinics.

Sources, checked October 14, 2026: Wegovy prescribing information (DailyMed); Zepbound prescribing information (DailyMed); HHS bulletin on online tracking technologies; FTC guidance on consumer health information; FTC v. Hims & Hers press release, complaint and case page.

Frequently Asked Questions

What should a GLP-1 telehealth intake form screen for?

What the Wegovy and Zepbound labels flag: a personal or family history of MTC or MEN 2, a past serious allergic reaction, other GLP-1 use, pancreatitis, gallbladder disease, diabetes medicines, severe gastroparesis, planned surgery, and pregnancy or breastfeeding (Wegovy; Zepbound). A licensed clinician reviews the answers and makes the eligibility call.

Does the Wegovy or Zepbound label set a BMI cutoff?

Not in the indication. Both labels name adults "with obesity" or with overweight plus at least one weight-related comorbid condition; the BMI figures (30 or more, or 27 to under 30 with a condition) describe who the main weight trials enrolled (Wegovy Study 2, 14.2; Zepbound Study 1, 14.1).

Are GLP-1 intake form answers protected health information?

On a HIPAA covered entity's form, yes: HHS says tracking that collects a reason for seeking care typed or selected while booking means the entity "is disclosing PHI to the tracking technology vendor" (HHS bulletin). Outside HIPAA, the FTC Act still covers health information (FTC guidance).

Can I send GLP-1 quiz answers to Meta or Google?

For a HIPAA covered entity, not without a signed BAA and a Privacy Rule permission, or the patient's authorization (HHS bulletin), and Curve's BAA Directory lists Meta and Google Ads as not signing one. Outside HIPAA, the FTC Act still applies (FTC guidance). Curve Forms sends a neutral form event instead.

What did the FTC allege against Hims & Hers?

Among other claims, that it shared consumers' health information with ad platforms, including a Purchase Event fired on each submitted Intake Flow that carried identifiers such as email and IP addresses plus the treatment sought (complaint). The case is pending (case page).

Can Curve Forms screen out people who do not qualify?

Yes. Screening outcomes in Curve Forms screen people out by age, service area or insurance, each with its own end screen, and screened-out submissions send no conversion to ad platforms.

Talk to Curve Compliance

Book a demo. See how your GLP-1 intake would run in Curve Forms, hosted under the BAA Curve signs on every plan, with form events sent to Meta and Google Ads and the answers kept out. Curve's team does the setup, and most customers are live in about a week. Book a Curve Forms demo.