Communication Preferences

Please complete the form below so we can communicate with you appropriately regarding your care and available services.

Patient Intake & Communication Preferences

This form helps us communicate with you appropriately regarding your care and available services.

Basic Identification

First name

Last name

Phone

Program Identification

Are you currently enrolled in our medical weight management or GLP-1 program?

Yes

Care Communication Preferences

For care-related questions, medication concerns, or clinical issues, please use the secure patient portal. This ensures your message is reviewed and documented appropriately.

How would you like to receive care-related updates and check-ins from Bluegrass Telehealth? These messages may include check-ins, reminders or important updates. They are not intended for urgent or complex medical questions.

Text messages (SMS)

Marketing & Program Updates

Would you like to receive occasional email messages about programs, services or special offers from Bluegrass Telehealth?

Yes

Would you like to receive occasional text messages about programs, services or special offers from Bluegrass Telehealth?

Yes