Contact Us info@firststepweightloss.com404-884-14617544 Southlake Pkwy Suite 102, Jonesboro, GA 30236 Intake Form Name * First Name Last Name Date of Birth * MM DD YYYY Email * Phone * (###) ### #### Medical Information * Please provide details of your current medications, chronic conditions, allergies, and any past surgeries Weight loss goal * Please provide your current weight and your target weight. Additionally, share any specific goals or milestones you aim to achieve through our program. Thank you!