"*" indicates required fields Step 1 of 5 20% Do you agree and consent to the following:Please be aware this an private service and prices start from £129 per month and increases as treatments strengths increaseWe are partnered with Pharmadoctor as our medical professional. They will send you an email to confirm enrollment on our service. Please confirm you are happy with this?* Yes No Personal detailsName* First Email* Phone*Date of birth* DD slash MM slash YYYY Which ethnicity are you?*Healthy BMI ranges are different according to your ethnic background. Asian or Asian British Black (Caribbean, African) Mixed ethnicities Other ethnic group White What sex were you assigned at birth?* Male Female What is your weight?* Kg st/lbs Enter weight in kg*Enter weight in st*Enter weight in lbs*What is your height?* Cm ft/in Enter height in cm*Enter height in ft*Enter height in inch* Have you been diagnosed with diabetes?*Diabetes treatments can impact the way the medication included with our weight loss plan works. I have diabetes and take medication for it I have diabetes and it's diet-controlled No, but there is history of diabetes in my family I have pre-diabetes I don't have diabetes Do any of the following statements apply to you?*These conditions can lead to serious complications when losing weight or taking weight loss medications. I have chronic malabsorption syndrome (problems absorbing food) I have cholestasis I’m currently being treated for cancer I have diabetic retinopathy I have severe heart failure I have a family history of thyroid cancer and/or I’ve had thyroid cancer I have end-stage kidney disease I have a history of pancreatitis I have or have had an eating disorder such as bulimia, anorexia nervosa, or a binge eating disorder I have had surgery or an operation to my thyroid I have had a bariatric operation such as gastric band or sleeve surgery None of these statements apply to me Do any of the following statements apply to you?*These conditions are often weight related and may be improved as a result of losing weight. I have been diagnosed with a mental health condition such as depression or anxiety My weight makes me anxious in social situations I have joint pains and/or aches I have osteoarthritis I have GORD and/or indigestion I have a heart/cardiovascular problem I’ve been diagnosed with, or have a family history of, high blood pressure I’ve been diagnosed with, or have a family history of, high cholesterol I have fatty liver disease I have sleep apnoea I have asthma or COPD I have erectile dysfunction I have low testosterone I have menopausal symptoms I have polycystic ovary syndrome (PCOS) None of these statements apply to me Do you have any other medical conditions?* Yes No Have you ever taken any of the following medications to help you lose weight?*These conditions are often weight related and may be improved as a result of losing weight. Wegovy Ozempic Saxenda Rybelsus Mounjaro Alli Mysimba Other I have never taken medication to lose weight Do you currently take any other medication or have any allergies? This includes prescribed medication, over-the-counter medication, and supplements. Select all that apply to you.*It’s really important that we know about any medication you're taking so that we can make sure there are no interactions with your weight loss plan. I’m on levothyroxine I’m on warfarin Other / I take more than one prescription medication I don’t take any medication I have allergies Would you like your GP to be informed of this consultation?* Yes No Please enter your GP's email address* Select product* Wegovy 0.25mg£129.00 0.5mg£179.00 1mg£179.00 1.7mg£219.00 2.4mg£269.00 Mounjaro 2.5mg£169.00 5mg£179.00 7.5mg£199.00 CommentsThis field is for validation purposes and should be left unchanged.
