Treatment Reorder Form

Please answer following questions...

If you're having difficulty answering these questions, don't hesitate to get in touch with us.

If you are ordering weight loss medication, please calculate your current BMI:

Please select either Metric or Imperial measurements :

Metric (Centimetre and Kilograms)
Imperial (Feet and Pounds)

BMI Calculation :

If you are ordering weight loss medication, please confirm on what date you last injected and what dose this was.

Have you started any new medication since your last order?

Yes

Are you suffering from any side effects from your medication?

Yes

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