To help us understand that this treatment is the right option for you, please answer the following questions. If you get stuck or need any help, you can contact us.

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Please provide your answer in the following format 00/00/0000



  • Weight loss medications are not a replacement for a healthy lifestyle and should be used alongside a calorie-controlled diet and increased physical activity.
  • Only one type of weight loss medication can be used at the same time.
  • If your body mass index is over 40, other treatments like bariatric surgery may be more beneficial. To consider your other options, you should speak to your doctor. Here is more information on Obesity.
  • We will need you to upload some photos to check your identity and current weight.
  • We will also need to let your GP know that you are using this service.

Male
Female

Please provide in cm


Please provide in kg




We understand that not everyone with an eating disorder has been diagnosed. It is important to note that: Appetite suppressants can trigger those with bulimia or anorexia. Binge eating may lead to results being different than expected. If you think you may have an eating disorder, please speak to your doctor, who can assess you further. Here is more information on Eating disorders




  • Acromegaly or any growth hormone problem
  • Chronic Malabsorption Syndrome
  • Cushings Syndrome
  • Gallbladder, Bile duct or Pancreas disease
  • Gastric surgery (bariatric surgery)
  • Heart Failure
  • Hypoglycaemia
  • Kidney Disease
  • Liver Disease
  • Pancreatitis
  • Severe gastrointestinal disease (e.g. inflammatory bowel disease, ulcerative colitis, Crohn's disease)
  • Type 1 Diabetes





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If yes, provide details of the medication, dose, start date and how long have you been on the treatment? How much did you weigh when you started this treatment?


If yes, provide the name of the medication and dose.


If Yes, which medication(s) did you use to help you lose weight?



If yes, please tell us more about your side effects, including the name and dose of the medication that caused them.



  • This is your first order of with us and you do not order the starter dose
  • Your last order with us was more than 8 weeks ago and you wish to order a higher strength


If you do, what is your current dose and when was your latest thyroid blood test?





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To confirm it’s you, please take a selfie of yourself holding your passport or driving licence next to your face.

Only .jpg, .jpeg, .png, and .gif formats are allowed.(10MB file size limit)

The last image we need is one of your full, front-facing profile from head to toe. Why do we need this photo? Our priority is patient safety. As injectable weight loss treatments are only suitable for people with a BMI over 27, our clinicians will review this photo to confirm before prescribing. You can be fully clothed, we ask that you wear clothes that make your body shape visible, such as leggings and a fitted vest or t-shirt.

Only .jpg, .jpeg, .png, and .gif formats are allowed.(10MB file size limit)

  • You will read the patient information leaflet supplied with your medication
  • You will contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
  • The treatment is solely for your own use
  • You have answered all the above questions accurately and truthfully. You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health.

I understand that the medications available are for weight loss only. I acknowledge that it is important to read and follow the instructions provided with the medication. 


I consent to the use of my personal and health information to provide appropriate medication recommendations. I understand that my information will be kept confidential and used in accordance with privacy regulations.


I confirm that the information provided is accurate and complete to the best of my knowledge. I agree to the terms and conditions of purchasing medication from this online pharmacy.