To help us understand that one or more of our treatment options are right for you, please answer the following questions. If you get stuck or need any help, you can contact us.

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You are eligible for treatment if your BMI is 30 or above. Alternatively, a BMI of 27 or above if you have certain health condition(s).

 

If you have already started weight-loss injection treatment you can continue treatment until a minimum BMI of 22.5.

Please select either Metric or Imperial measurements :

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

• Asthma

• Chronic back pain

• Depression linked to weight

• Erectile dysfunction

• Fatty liver disease

• High blood pressure

• High cholesterol

• Osteoarthritis (in the hip, back or knee)

• PCOS

• Sleep apnoea

• Type 2 diabetes / Pre-diabetes / Insulin-resistance

 

The presence of any of the above conditions means you may be suitable for treatment with a lower minimum BMI of 27.


We ask this because there is an increased risk of health conditions in certain ethnic backgrounds at a lower BMI, therefore you maybe eligible for weight loss treatment with a lower BMI.

Asian or Asian British
Black, Black British, Caribbean or African
Mixed or multiple ethnic groups
White
Other ethnic group
I don't know or don't wish to answer

• Acromegaly or any growth hormone problem

• Cancer (current)

• Cushing’s syndrome

• Eating disorder (current or previous) e.g. anorexia, bulimia

• Gallbladder, bile duct or pancreatitis

• Heart failure

• History of inflammatory bowel disease or gastroparesis

• Kidney disease

• Liver disease

• Multiple endocrine neoplasia

• Personal or family history of medullary thyroid cancer

• Type 1 diabetes or diabetic retinopathy



  • You are trying to conceive.
  • You are pregnant or intending to become pregnant?
  • You are breastfeeding or going to start breastfeeding whilst taking this medication?

If yes, please confirm:

  1. Drug name
  2. Drug strength
  3. Date of last dose
  4. Weight before you started treatment

This includes prescription, over-the-counter, purchased online or recreational drugs?



• There may be an increased risk of pancreatitis, gall bladder problems and gall stones with this medication, and that if you experience any abdominal pain whilst using this medication you should seek medical advice.


• Injectable weight loss medications should not be used with other weight loss medications.


• If you develop any lumps in the neck or a hoarse voice whilst taking this medication, you should stop the medication and speak to your doctor.


• Weight loss has been associated with a lowering of mood (depression), and if you are experiencing this, you should stop the medication and speak to your doctor.


• This medication should not be used by men or women that are trying to conceive or pregnant. You must discontinue treatment at least 2 months before trying for a child.

• Once you have completed this consultation form, we will process your payment. However, please note that this does not guarantee treatment approval. If we determine that you are not suitable for treatment, we will issue a full refund.


• To inform both us and your GP about any treatment related side-effects, the initiation of new medication, or changes in your medical conditions during the course of treatment.


• To read the patient information leaflet provided with your medication before using your new treatment. If you have any questions you can contact our support team or your GP.


• To submit a recent photograph of yourself for verification purposes if requested. Please see our FAQs page for more information.


• The prescribed treatment is intended exclusively for your personal use.


• You have provided accurate and truthful responses to all the preceding questions.


• You acknowledge that our prescribers rely on your responses as truthful and honest to make prescribing decisions and recognise that inaccurate information may result in serious health risks.


• You consent to us sharing consultation information with your GP? (Required).


• You Agree to our Terms & Conditions


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