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Kansas City & Topeka Medical Weight Loss & Healthy Aging Specialists

Schedule Appointment by Phone

To schedule your FREE no-obligation consultation and body-composition analysis by phone, please call:

Schedule Appointment Online

To schedule your FREE no-obligation consultation and body-composition analysis online, simply complete the form below. One of our helpful and courteous staff members will contact you at the time of your preference to arrange an appointment that best suits your schedule.

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1Contact Info

2Medical Info

3Scheduling

Which location do you prefer to visit?

Which location do you prefer to visit? *-- Please Select --Kansas City (Leawood, KS)Topeka, KS

Your Contact Information

scheduling referred We

Your Name *

First

Last

Email Address *

Mobile Phone

Contact - Mobile

• OK to leave a voicemail
• OK to send a text to this number

Alternate Phone

Contact - Alternate

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• OK to send a text to this number

Do you agree to receive SMS texts? (required) *

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Confidential Information (for your medical records)

Approximately how much weight would you like to lose?-- Please Select --5-14 pounds15-24 pounds25-34 pounds35-49 pounds50-75 poundsOver 75 pounds

Which Services are you Interest in?

• Hormone Evaluation with Treatment Options
• Weight Loss & Optimal Body Composition
• Metabolism Acceleration & Enhanced Fat Burning
• Appetite Control Medications
• Cardiac Health (Stroke & Heart Attack Prevention)
• Muscle Health (Osteoporosis & Frailty Prevention)
• Brain & Memory Health (Dementia Prevention)
• Individualized Dietary & Supplement Plan
• Energy & Mood Enhancement

Please feel free to mark as many services you would like to know more about. Our highly trained medical staff will be happy to share all the information and guidance you need.

Tell us about your top health goals

Date of Birth *

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Gender-- Please Select --FemaleMale

Your Mailing Address

Address Line 1

City

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Zip Code

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When is the best time to contact you to finalize the scheduling of your appointment?

We'll contact you at your preferred time to complete the scheduling of your appointment.

Best days to contact you:

• Mondays
• Tuesdays
• Wednesdays
• Thursdays
• Fridays

Best times to contact you:

• Early Mornings (before 8am)
• Mornings (8am-12pm)
• Lunch (12pm-1pm)
• Afternoons (1pm-5pm)
• Early Evening (5pm-6:30pm)

Special note about contacting me...

We will do our best to contact you during your preferred time(s). Let us know here if you have any special requirements when contacting you and we'll do our best to accommodate you.

How did you hear about us? *-- Please Select --I am a current / former patient at CFNFriend / ColleagueOnline Search / WebsiteSocial MediaRadio / TelevisionMagazine / Print PublicationOther

What is the name of the person who referred you so we can say thanks?

What social media platform did you learn about us on?

What station / channel did you hear about us on?

What magazine or publication did you see us in?

Other: Where did you hear about us?

Questions or Comments

Do you have any questions or concerns about your Initial Consultation? We are here to help you!

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