Weight Loss (Injectables)

What is your current WEIGHT and HEIGHT?

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 upload a clear photo of yourself holding either a piece of paper with today’s date or your ID, ensuring your face is fully visible.

Accepted formats: HEIC, PDF, JPG, PNG

Important: Missing or unclear images may delay your order.

Do you have any of the following conditions:

• 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.

What ethnicity background best describes you?

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.

Have you been diagnosed with any of the following?

• 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

Have you been diagnosed with any other health condition(s)?

Do any of the following apply to you?

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?

Are you currently taking or previously had weight loss injections?
If yes, please confirm:
- Drug name
- Drug strength
- Date of last dose
- Weight before you started treatment

Are you currently taking any other medication?
This includes prescription, over-the-counter, purchased online or recreational drugs.

Provide more info in the box if so.

Have you experienced an allergic reaction to weight-loss injections?

Do you understand and agree to the following:
• 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.

Do you agree to the following terms and conditions?
• 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

Is there anything else you would like to tell us?