Welcome to TOM Weight Loss

This form is the first step in your free consultation with Dr. Le! This entire health history form should take less than 20 minutes to complete. 

• If you are starting a messaging consultation, Dr. Le will contact you to discuss all of your options within 12 hours of receiving this form (or slightly longer if submitted between the hours of 8pm - 2am).  
• If you are completing the form for a phone or video consultation, Dr. Le will review it with you during your appointment.
• Most patients who qualify have their prescription at the pharmacy within 12 hours of becoming members.

If you experience any problems with the form, text us directly at 713-568-9102 so that we can help. You're so close to starting your weight loss journey!