Your health and safety are our top priorities. To ensure we provide you with the most effective and appropriate treatment, it is crucial that you provide accurate and complete information about your health during our online consultation process. Accurate information helps us understand your condition better, assess any potential risks, and recommend the best possible medication for your needs. Providing false or incomplete information can lead to inappropriate treatment, potential health risks, and delays in receiving the care you need. Thank you for your cooperation and trust in our services.

0%


Male
Female
Transmale (Born a female)
Transfemale (Born a male)

White
Asian or Asian British
Black, Caribbean or African
Mixed ethnicity
I prefer not to say

If yes, please list them.


High blood pressure
High cholesterol
PCOS
Sleep apnoea
Type 2 Diabetes or pre-diabetes
None of the above

If yes, please list them.


If yes, please list them:


Current cancer
Under specialist for liver or kidney disease
History of pancreatitis
History of gastroparesis
Gallstone symptoms in last 12 months
Gallbladder removed in last 3 months
Crohns or Ulcerative Colitis symptoms in last 6 months
Personal or family history of medullary thyroid cancer
Previously diagnosed anorexia or bulimia
Type 2 diabetes treated with medication OTHER than metformin
Heart failure
None of the above

Pregnant
Planning to get pregnant in the next 2 months
Not applicable

Yes
No
Not applicable



Accurately describing your condition during our online consultation is essential for ensuring you receive the best possible care. Detailed and truthful information about your symptoms, their frequency, and their severity allows our healthcare professionals to make informed decisions about your treatment. Incomplete or incorrect descriptions can result in inappropriate medication, potential health risks, and delays in your care. Your honesty and thoroughness help us provide you with the most effective and safe treatment options. Thank you for your cooperation and trust in our services.

0%

Please select either Metric or Imperial measurements :

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


If yes, please confirm the name, dose and the date of your last injection.



If yes, please describe:




Please take the time to carefully read the Agreement and Consent statements during our online consultation process. Understanding these statements is essential for your safety and for ensuring that you are fully informed about the treatment you will receive. The Agreement and Consent sections outline important information about the risks, benefits, and responsibilities associated with your medication. By reading and agreeing to these terms, you help us ensure that you are aware of and comfortable with the treatment plan. Your informed consent is crucial for providing you with the best possible care. Thank you for your cooperation and trust in our services.

0%

I have been informed about the potential side effects and interactions of the prescribed medication for weight loss.


I agree to consult with my healthcare provider before starting any new medication. 

I understand that the information provided in this assessment will be reviewed by a licensed clinician before my order is processed. 


We may need to arrange a video call to visually verify your BMI if there is no recent BMI on your NHS record.


I consent to my GP being informed if I am prescribed any medication.


I consent to my personal and medical information being used to assess my suitability for the prescribed medication.

I understand that my information will be kept confidential and used solely for the purpose of this assessment. 


I confirm that the information provided in this assessment is accurate and complete to the best of my knowledge.

I understand that providing false information may result in my order being cancelled and may have health implications.