Ozempic Face Clinical Research Study Interest
Please fill out the below form in it's entirety to be considered for a ground-breaking clinical research study.
Full Name
*
Email
*
Phone
*
Gender
*
Male
Female
Other
Address
*
City
*
State
*
Date of Birth
*
Height
*
Weight
*
Target weight loss goal
*
Less than 20lb
20-30lb
30-40lb
Greater than 40lb
Are you planning to start a GLP-1 receptor agonist medication (e.g., Ozempic®, Wegovy®, Mounjaro®, semaglutide, tirzepatide) for weight management, prescribed by your healthcare provider?
*
Yes
No
Have you already taken any doses of this medication?
*
Yes
No
This study requires that your first dose of the GLP-1 medication be taken at your baseline study visit (Day 0), to ensure all facial measurements are taken before any weight loss begins. Are you willing and able to coordinate the start of your medication?
*
Yes
No
In the past 6 months, have you undergone any of the following procedures? (Check all that apply)
Facial fillers (e.g., Juvéderm®, Restylane®, Radiesse®) or fat transfer
Thread lifts or surgical facelifts
Energy-based facial treatments (e.g., laser resurfacing, microneedling with radiofrequency, ultrasound)
I have not undergone any of these procedures
Do you have any of the following? (Check all that apply)
Known allergy or hypersensitivity to Calcium Hydroxylapatite (CaHA) or lidocaine
A history of severe anaphylactic reactions requiring epinephrine
Active dermatologic conditions on the face (e.g., severe acne, psoriasis, rosacea) or significant scars that could interfere with assessments
A bleeding disorder that would make injections unsafe
An immunosuppressive condition, or are you taking immunosuppressant medication
Uncontrolled diabetes or other major comorbid conditions that would make participation unsafe
A diagnosis of Body Dysmorphic Disorder or other uncontrolled psychiatric illness
Active or previous eating disorders
A history of adverse reactions to aesthetic filler/neurotoxin treatment
A diagnosis of any thyroid disorders that affect weight management (hyper- or hypo-thyroid disorders)
None of these apply to me
Are you currently pregnant or breastfeeding?
*
Yes
No
If you are a woman of childbearing potential, are you willing to use an effective method of contraception throughout the study?
*
Yes
No
Are you planning to undergo bariatric surgery or any other significant weight loss intervention during the next 12 months?
*
Yes
No
Please confirm your understanding and willingness to comply with the following study requirements:
I am willing and able to attend all study visits over a 12-month period at the study site in Pasadena, CA.
*
I am willing to receive facial injections of Radiesse as part of the study procedures.
*
I am willing to have 2D, 3D, and AI-based facial photographs and scans taken at multiple study visits.
*
I understand that I will be randomly assigned to either an immediate treatment group or a delayed treatment (control).
*
I agree to be contacted by the study team to discuss my eligibility further.
*
By submitting this form and signing up for texts, you consent to receive marketing text messages (e.g. promos, cart reminders) from [Your Company Name] at the number provided. Consent is not a condition of purchase. Msg & data rates may apply. Msg frequency varies. Unsubscribe at any time by replying STOP.
Submit
Marketing by
ActiveCampaign