*****YOU MUST BE PRESENT IN IDAHO OR WASHINGTON STATE DURING YOUR VISIT****
How does care at AVIVA Northwest work?
AVIVA Northwest is a medication assisted weight loss clinic providing telehealth care to you in your home. Aviva Northwest is staffed by pharmacists with special training in weight loss treatment and weight loss medication management. To start, you will need to schedule a virtual initial consultation to establish care with AVIVA Northwest. We will evaluate your goals and options for medication assisted weight loss, and review your risks and benefits of weight loss with medication assistance. We will collect payment at this visit. You may need to obtain additional lab work at your own expense before treatment can begin. AVIVA Northwest staff will order this lab work for you, if it is needed.
INITIAL VIRTUAL VISIT CONSULTATION TO ESTABLISH CARE
FOLLOW UP VIRTUAL VISITS
ONGOING CARE
You have the option to make an appointment at any time during normal business hours with a provider at AVIVA Northwest. This can be scheduled by you by choosing an open appointment through your patient portal scheduling option or by messaging or calling the office.
We will collect payment at time of each visit.
PAYMENT FOR CARE:
AVIVA Northwest does not bill medical insurance for the cost of your care. You will be responsible for payment of services. AVIVA Northwest accepts credit cards, debit cards and health savings cards as method of payment. You will be asked to enter your payment information at time of scheduling your appointment. Your payment will be charged at time of check-in to your virtual appointment.
CANCELLATION AND REFUND POLICY
Unfortunately, AVIVA Northwest is unable to give any refund after you make your payment for a visit or fill a medication order. The medication and virtual visit services are non-refundable and non-returnable.
You are responsible to cancel your appointment 24 hours in advance or you will be automatically billed a cancellation fee of $100. If you do not cancel your appointment within 24 hours, you are responsible to pay AVIVA Northwest the cancellation fee.
PRICES
Prices are subject to change based on medication and overhead costs of doing business. Prices are displayed and available on our website when you choose to book your appointment. Prices vary based on services you chose to receive from AVIVA Northwest.
APPOINTMENT SCHEDULE WHEN RECEIVING WEIGHT LOSS MEDICATION
If you chose to start a new weight loss medication, AVIVA Northwest will require monthly virtual visit to evaluate, monitor, assess, titrate, and continue your medicine until you are titrated to the maximum tolerated dose of medicine. We see you monthly to ensure the medication dose is safe and effective for you and you are not experiencing adverse effects. Monthly visits usually occur for 6 months while you are titrated on the medicine. We will collect visit payment at each monthly visit and will order the pharmacy to dispense 4 weeks of medication at each visit, if you continue the medication. Once you are fully titrated on your medicine and tolerating the dose, AVIVA Northwest will require a virtual visit every 3 months. When you are on a stable dose of medicine, we will reorder your prescription to the pharmacy of your choice. We will collect payment at time of each visit and at the medication ordering.
The payment will depend on the medication you are taking and the quantity you would like to refill.
MEDICATION REFILLS
Medication refills can be requested via the secure patient portal messaging or by calling our office or by scheduling a virtual visit. Schedule appointments and contact our office at least 7 days before your refill is due to ensure you receive your medication before your dose is due.
ESSENTIALS OF WEIGHT LOSS CONSULTATION, MANAGEMENT AND MONITORING
What is my diagnosis? Your diagnosis is based on your body mass index (BMI)
BMI 25-29.9 = Overweight
BMI 30-34.9 = Class 1 Obesity
BMI 35-39.9 = Class 2 Obesity
BMI > 40 = Class 3 Obesity (Morbid or Severe Obesity)
Why is treating Overweight and Obesity important?
Being above ideal body weight and having obesity puts you at risk for many health problems. By keeping a healthy weight, you will likely reduce your risk of type 2 diabetes, high blood pressure, high cholesterol, heart disease, stroke, certain types of cancer, liver disease, acid reflux, gallbladder disease, sleep apnea, and aches and pains.
How do I get care for medication assisted evaluation and management for overweight and obesity treatment?
Simply schedule an appointment with AVIVA Northwest. Visit AVIVANW.COM and book an appointment. We will meet with you virtually to review your health history and weight loss goals to determine if you are a candidate for weight loss with medication assistance.
What medications are available for weight loss assistance at AVIVA Northwest?
MEDICATIONS: SEMAGLUTIDE and TIRZEPATIDE
Semaglutide and Tirzepatide are glucagon-like peptide 1 (GLP-1) receptor agonist. These medicines are commonly used to treat diabetes by lowering blood glucose levels. They are FDA approved as a weight loss medication for obese and overweight patients.
These medications stimulate the hormone GLP-1 in the body. GLP-1 is an important, gut-derived, regulator that is released after you eat food with carbohydrates or fats. GLP-1 make your body release insulin, lower glucagon secretion (glucagon increases sugar production), slow stomach emptying, and reduces appetite and food intake, and tell parts of the brain that you are full.
Who should consider taking Semaglutide or Tirzepatide for weight loss?
Adults 18- 75 years of age with a BMI of at least 30
Adults 18- 75 years of age with a BMI of at least 27 with weight-related health problems
What are the side effects of Semaglutide and Tirzepatide?
The most common side effects may include nausea, diarrhea, constipation, vomiting, stomach/abdominal pain, headache, fatigue, upset stomach, dizziness, bloating, belching, gas, heartburn, and sometimes low blood sugar. These symptoms are most common when you first start taking the medicine. To limit nausea, eat bland, easy to digest, low-fat foods; stay hydrated; avoid laying down after eating; eat slowly; and get mild activity after eating.
Rare, serious side effects include bowel blockage, gastroparesis (stomach paralysis), and pancreatitis. You must discontinue the medicine immediately and seek immediate medical attention if these occur.
If you take injectable formulas of Semaglutide or Tirzepatide there are potential risks associated with injections to include, but are not limited to, the risk of infection at the site of injection, bleeding at site of injection, scar tissue formation and discomfort or pain at site of injection.
Am I Good Candidate for Semaglutide or Tirzepatide?
Adults 18-75 years old with a BMI above 30.
Adults 18-75 years old with a BMI above 27 with health-related conditions could likely benefit from Semaglutide and Tirzepatide.
Who Should Not Take Semaglutide or Tirzepatide?
Do not take Semaglutide or Tirzepatide if:
Will I Still Need to Manage My Diet and Exercise?
Yes. In fact, it is essential even though Semaglutide and Tirzepatide will help you manage your weight. These medicines should not be thought of as a sole and only solution for weight loss or a substitute for healthy eating and/or exercise. A healthy diet and regular exercise are critical for optimal health and weight loss.
SEMAGLUTIDE OR TIRZEPATIDE ARE GLP-1 AGONISTS
OVERVIEW OF GLP-1 AGONIST PRODUCTS
Semaglutide is the active ingredient found in the Brand Medication Products : Ozempic and Wegovy
Tirzepatide is the active ingredient found in the Brand Medication Products : Mounjaro and Zepbound
These medications currently come in 3 dosage forms:
1. Compounded formulations used for subcutaneous injection labeled semaglutide or tirzepatide
2. Compounded Drops that go under the tongue (Sublingual) labeled as semaglutide or tirzepatide.
3. Commercially Available Prepackaged syringes marketed as Ozempic, Wegovy, Mounjaro, Zepbound
NOTE: Compounded Semaglutide and Tirzepatide can be compounded at a 503B pharmacy pursuant to a patient-specific prescription ONLY while the commercially manufactured product is on national shortage as determined by the FDA.
1. SEMAGLUTIDE OR TIRZEPATIDE- COMPOUNDED GLP-1 AGONIST SUBCUTANEOUS INJECTIONS
Dose and Frequency:
Follow the instructions on your pharmacy prescription label. If you have questions or are uncertain about the instructions call AVIVA Northwest immediately at 509-868-6023 and do not take your medicine until you have clear instructions.
Injectable Semaglutide and Tirzepatide dose will be increased slowly every month until reaching the maximum tolerated dose. A subcutaneous injection (into the fat layer in your stomach area) dose is given once a week, taken on the same day each week, any time of day, with or without food. You or your caregiver can administer the subcutaneous injection into a fatty abdominal area.
IMPORTANT: THIS PRODUCT FOLLOWS A TITRATION SCHEDULE.
ALL PATIENTS MUST START WITH MONTH 1 DOSE.
AFTER MONTH 1, THE DOSAGE PER INJECTION MAY BE INCREASE GRADUALLY NO MORE FREQUENTLY THAN EACH MONTH AT MONTH 2, 3, 4, 5 and 6 DEPENDING ON HOW WELL YOU TOLERATE THE MEDICINE.
LASTLY THE MAINTENANCE DOSE CAN BE ONGOING DEPENDING ON YOUR GOALS.
Vitamin B12 or B3 may be added to your injected medicine.
Vitamin B12 is a B vitamin also called Cyanocobalamin. Vitamin B3 is also called niacinamide. These vitamins may reduce some of the side effects of Semaglutide and Tirzepatide, such as nausea. Some compound pharmacies add to your medication formula.
What if I cannot tolerate the side effects of an increased dose?
If you are unable to tolerate a particular dose, notify AVIVA Northwest and they may recommend that you decrease your dose to the previous tolerated dose and continue for 4 weeks. Then you can try to increase your dose again. You can always choose to stop your GLP-1 agonist weight loss medication if you are not tolerating the medicine.
How do I Inject the Medicine?
To prepare for a subcutaneous injection (into the fat layer in your stomach area) injections of compounded medication you will need your medicine, a medication syringe, an alcohol swab and a puncture proof container.
Gather your supplies. Wash your hands. Sit in a comfortable place.
The plastic top on the medicine vial will need to be removed from the medicine vial the first time you use the medication. After removing the plastic top, clear the top of the vial and your injection site with the alcohol pad.
Remove the cap from the syringe needle and pull air into the syringe that matches your medicine dose.
Poke the needle into the rubber stopper on the medicine vial.
Push the air into the vial then turn the vial upside down while the syringe is inserted in the vial and allow the medicine to cover the needle.
Slowly pull back the plunger on the syringe until the medicine fills the vial to the dose you are prescribed on the prescription label. Remove any air so the syringe is only full of medicine to the dose mark on the syringe that matches the dose you take.
Pinch about 1 inch of the abdominal injection site. Inject at least two inches away from the belly button, scars, moles or other blemishes, on either side of your abdomen.
Insert the needle into the skin between the index finger and thumb at 90 degrees. Using a slow and constant pressure, push the plunger rod until it reaches the bottom of the syringe near the needle and all medicine is injected. Gently pull the syringe out of the skin.
DO NOT RECAP THE SYRINGE.
Place the syringe in a puncture proof container. Dispose of needles in an empty hard, closed container, such as a plastic milk jug or sealable bottle or in a medical sharp's containers (available at your retail pharmacy).
Alternate injection sites between either side of the stomach each week. Subcutaneous injections will typically cause very little pain because it is only injected directly under the skin.
HOW TO TAKE COMPOUNDED Semaglutide and Tirzepatide INJECTIONS
If you chose to use the injectable compounded Semaglutide or Tirzepatide you will schedule your first monthly virtual evaluation and management visit with AVIVA Northwest. A 4-week supply of medication will be included in the cost. We will collect payment at that visit. An order for 4 weeks of the chosen medication will be sent to the compounding pharmacy, then shipped to your home or picked up by you at the pharmacy. Typical turnaround time is 1 week. We will order the pharmacy to dispense the first 4 weeks of medication to you. In about 1 week, once you receive your medication, you will schedule a virtual visit with AVIVA Northwest to review and train you how to use your medicine properly and safely. This cost is included in the initial first month evaluation and management visit.
AVIVA Northwest will require a monthly virtual visit to evaluate, monitor, assess, titrate, and continue your medicine until you are titrated to the maximum tolerated dose of medicine. This usually takes 6 months. We will collect payment at each visit and each time we order the pharmacy to dispense 4 more weeks of medication. Your medication will arrive about 1 week after reordering. You will be required, at a minimum, to complete a health screening questionnaire before medication is refilled to ensure you are tolerating the medication safely and effectively. Notify AVIVA Northwest monthly of your refill request at least 7 days before you need your medicine.
Once you are fully titrated on your medicine and tolerating the dose, AVIVA Northwest will require a periodic visit based on your care needs. You must have a telehealth visit at a minimum every year to continue care at AVIVA Northwest.
NOTE: Compounded Semaglutide and Tirzepatide can be compounded at a 503B pharmacy pursuant to a patient-specific prescription only while the commercially manufactured product is on national shortage as determined by the FDA.
How do I store injectable Semaglutide or Tirzepatide?
Keep Semaglutide and Tirzepatide medicine out of reach of children.
Follow the storage and disposal instructions on your prescription label. Contact our office if need assistance.
2. SEMAGLUTIDE OR TIRZEPATIDE (GLP-1 AGONIST)- COMPOUNDED SUBLINGUAL (SL) DROPS
SUBLINGUAL Semaglutide or Tirzepatide Drops Dose and Frequency:
Follow the instructions on our pharmacy prescription label. If you have questions or are uncertain about the instructions call AVIVA Northwest immediately at 509-868-6023 and do not take your medicine until you have clear instructions.
How do I use sublingual (SL) Semaglutide or Tirzepatide?
Place 0.1ml under tongue every morning (30-60 minutes prior to breakfast or eating). May increase by 0.1ml every 1-2 weeks until effective. DO NOT USE MORE THAN 0.5ml PER DAY. You may divide the doses throughout the day taking your 0.1ml prior to meals.
Sublingual (SL) Dose and Frequency
Your sublingual Semaglutide or Tirzepatide dose will be increased slowly every month until reaching the maximum tolerated dose. A sublingual dose is given under the tongue. These medicines will be titrated over 6 months to up to a maximum dose of 5 doses per day.
The dose is taken 30-60 minutes prior to meals.
IMPORTANT: THIS PRODUCT FOLLOWS A TITRATION SCHEDULE.
ALL PATIENTS MUST START WITH MONTH 1 DOSE.
AFTER MONTH 1, THE DOSAGE PER INJECTION MAY BE INCREASE GRADUALLY NO MORE FREQUENTLY THAN EACH MONTH AT MONTH 2, 3, 4, 5 and 6 DEPENDING ON HOW WELL YOU TOLERATE THE MEDICINE.
LASTLY THE MAINTENANCE DOSE CAN BE ONGOING DEPENDING ON YOUR GOALS.
How do I store sublingual Semaglutide or Tirzepatide?
Keep Semaglutide and Tirzepatide medicine out of reach of children. Store sublingual doses as directed by your dispensing pharmacy.
SUBLINGUAL (SL) COMPOUNDED Semaglutide
If you chose to use the sublingual (SL) compounded Semaglutide, you will schedule a monthly virtual evaluation and management visit with AVIVA Northwest. A 4-week supply of medication will be included in the cost. We will collect payment at that visit. An order for 4 weeks of the chosen medication will be called into the compounding pharmacy, then shipped to your home or picked up at the pharmacy by you. Typical turnaround time is 1 week. We will order the pharmacy to dispense the first 4 weeks of medication to you. In about 1 week, once you receive your medication, you will schedule a virtual visit with AVIVA Northwest to review and train you how to use your medicine properly and safely. This cost is included in the initial first month evaluation and management visit.
AVIVA Northwest will require a monthly virtual visit to evaluate, monitor, assess, titrate, and continue your medicine until you are titrated to the maximum tolerated dose of medicine. This usually takes 6 months. We will collect payment at each monthly visit and order the pharmacy to dispense 4 more weeks of medication at each visit. Once you are fully titrated on your medicine and tolerating the dose, AVIVA Northwest will require, at a minimum, that you complete a health screening questionnaire before medication is refilled to ensure you are tolerating the medication safely and effectively. Notify AVIVA Northwest monthly of your refill request at least 7 days before you need your medicine.
Once you are fully titrated on your medicine and tolerating the dose, AVIVA Northwest will require a periodic visit based on your care needs. You must have a telehealth visit at a minimum every 2 years to continue care at AVIVA Northwest.
COMMERICALLY AVAILABLE BRAND GLP-1 INJECTABLES: OZEMPIC, WEGOVY, ZEPBOUND, MOUNJARO
The pharmacist team will work with you to evaluate your medication insurance benefits, assist with evaluating medication coverage and assist with evaluating medication costs and options. If you chose to consider the use the commercially available injectable GLP-1 medicine, after your initial consult you will schedule a monthly virtual evaluation and management visit with AVIVA Northwest. We will collect payment at that visit for this evaluation. If you consent to start a commercially available product, AVIVA Northwest will order a 4-week supply of medication to the pharmacy of your choice. You will pick up and pay for the medication to the pharmacy dispensing the medicine. AVIVA Northwest has no control or influence over the cost of your medicine. Once you receive your medication, you will schedule and attend a virtual visit with AVIVA Northwest to review your medication plan and to train you how to use your medicine properly and safely.
This cost is included in the initial consult for initial medication evaluation, management and teaching.
AVIVA Northwest will require a monthly virtual visit to evaluate, monitor, assess, titrate, and continue your medicine until you are titrated to the maximum tolerated dose of medicine. This usually takes 6 months. We will collect a visit payment at each monthly visit and will order the pharmacy to dispense 4 more weeks of medication at each visit, if you continue the medication. Once you are fully titrated on your medicine and tolerating the dose, AVIVA Northwest will require, at a minimum, that you complete a health screening questionnaire before medication is refilled to ensure you are tolerating the medication safely and effectively.
Notify AVIVA Northwest monthly of your refill request at least 7 days before you need your medicine.
Once you are fully titrated on your medicine and tolerating the dose, AVIVA Northwest will require a periodic visit based on your care needs. You must have a telehealth visit at a minimum every 2 years to continue care at AVIVA Northwest.
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