Weight Loss

Complete this short assessment so our prescribers can determine if treatment is right for you.

Takes approximately 5 minutes
Step 1 of 4 25% About 5 min left
1
About You
2
Your Weight Loss History
3
Lifestyle
4
Acknowledgement

This consultation form helps our clinical team assess whether weight loss medication is suitable for you. Your answers are reviewed by a qualified prescriber before any treatment is recommended.

Please complete all sections as accurately as possible. Some questions may feel personal, but every answer helps us make the safest clinical decision for you. If you are unsure about any question, you can contact our Customer Care team for support before submitting.

This form is not a diagnosis and does not guarantee that medication will be prescribed.

If you’re not currently taking weight loss medication, we’ll email you a link to book a video consultation with a prescriber, after which your medication will be delivered.

1 About You

These questions help us understand who you are and your current health.

Weight
Height

2 Your Weight Loss History

Weight

3 Lifestyle

4 Acknowledgement

Please Note: If this is your first time taking this medication, you will only be allowed to order the initial strength for Mounjaro (2.5mg) and Wegovy (0.25mg). Following the initial dose, subsequent orders will be increased in strength using a stepwise approach.

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