Elite Health ~ Patient Before & Afters

First name

Last name

Medication I have used:

Semaglutide

Tirzepatide

Both

Age

Gender

Date I started my weightloss journey with the above medication

Month

Day

Year

Staring weight (in beginning photo)

Date current photo was taken

Month

Day

Year

Current weight (in photo):

Photo Consent:

I consent to the use of my uploaded photo to be used on Elite Health Solutions website and related social media sites.

I DO NOT consent to the use of my uploaded photo to be used on Elite Health Solutions website and related social media sites.

Privacy:

I allow Elite Health Solutions to show my face as it appears in my uploaded photos.

I require that Elite Health Solutions BLOCK OUT my face, before posting photos to the website or affiliated sites.

Photo tips:

Show the REAL you; form fitting clothing is best - no nudity
(we can block your face!)
No filters / editing / etc...
Try to use similar lighting & similar poses in both photos to show a great comparison
Patients may also just complete a testimonial without photos (but we do want to see your great results and share them!!)

Beginning Photo

Current Photo

Patient Testimonial:

Signature: By signing and submitting these photos / testimonial, I conset to use on the Elite Health Solutions web site and affiliated social media platforms

Signature field is empty.

Occupational Health Services
DOT Physicals | Drug Testing | Labs

Elite Health ~ Patient Before & Afters

ADDRESS

OPENING HOURS

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