Article / Brain – Keto5.com

Skip to main content

Skip to Content

What is Keto?
Weight Loss
Products
About Us

Medical professionals

Store
Account

Article / Brain

Posted on March 14, 2023

Lorem ipsum dolor sit amet, consectetur adipisicing elit. Illo alias iure quasi autem labore! Ipsum sapiente recusandae impedit, excepturi illo, reiciendis ut quae quibusdam ex dolorum expedita similique, corporis eaque.

Weight Loss
Products
About Us
More

Copyright 2023 Keto5

Privacy Policy
Terms and Conditions
HIPPA Compliance

Consult a Physician

Schedule an appointment with one of our Keto5 experts about our supervised keto weight loss program – all from the convenience of your own home.

Contact information

First Name

Last Name

Email

ZIP Code

We currently do not treat patients with Type 1 Diabetes

Do you have Type 1 Diabetes?*

Yes

No

Keto5 cannot treat patients with Type1 diabetes

1 of 6

Tell us about yourself

Units of Measurement

Imperial

Metric

Height

Weight

Gender

Birthdate

2 of 6

What are your reasons for losing weight?

Select all that apply

I struggle with obesity

I have problems with my joints

I suffer from chronic illness (e.g. Type 2 Diabetes)

I don’t have energy to do everyday tasks

I have heart problems

I want to maintain a healthy lifestyle

I have high blood pressure

Other

3 of 6

What diet programs have you done in the past?

Select all that apply

Bistro

Ketogenic Diet To Go

DoFasting

Noom

Fresh & Easy

Nutrisystem

Freshly Fit

Virta Health

Jenny Craig

Weight Watchers

Keto Cycle

Other

4 of 6

How familiar are you with a keto diet?

Have you tried keto on your own?

Yes

No

What was your biggest barrier to long-term success?

Tracking macros (e.g. amount of fat, protein and carbs)

Cost or access to ingredients

Carb carvings

Convenience

5 of 6

Do you have existing medical conditions?

Select all that apply

Acid Reflux

Pre-Diabetes

Type 2 Diabetes

Autoimmune Disorders

Arthritis

Kidney Disease 3

Disease

Cancer

Alzheimers

Kidney Disease

Asthma

Other

Hyperlipidemia

6 of 6

Thank you for submitting a request to talk to one of our certified keto physicians.

One of our physicians will be reaching out to you in the next 24 hours. Please check your inbox.

Close

Did you know that your Internet Browser is out of date?

X

Your browser is out of date, and may not be compatible with our website.

You can update your browser from the link below.

Download the latest version of your prefered browser

Close

×

Error