Professional Medical Assessment

Medical Weight Loss Consultation

Complete our comprehensive medical assessment for weight loss injection treatments. Our UK registered pharmacist will provide personalized recommendations.

HIPAA Compliant
UK Registered Pharmacist
24hr Response Time

Consultation Progress

0% complete

About You

Tell us about yourself to get started

Auto-fills st/lbs

About Your Health

Help us understand your medical history

Do you suffer from any heart problems? *
Do you have any thyroid problems? *
Thyroid cancer in you or immediate family? *
Pancreatitis (current or past)? *
Kidney problems? *
Liver problems? *
Severe gastro-intestinal problems? *
Diabetes? *
Mental health problems? *
Eating disorder? *
Other medical problems? *
Other medication not already identified? *
Known allergies? *
Permission to inform your GP? *

About Your Lifestyle

Tell us about your daily habits and routines

Do you smoke? *
Do you drink alcohol? *

Excessive alcohol can increase health risks. For support cutting down, visit this page.

Staying hydrated helps reduce constipation.

Poor sleep affects hunger hormones.

NB: 150 min moderate or 75 min vigorous recommended.

Your Weight Loss Journey

Tell us about your weight loss experiences and goals

What contributes to your excess weight? *
Currently taking any weight loss treatments? *

Declaration & Consent

Please review and agree to the terms and conditions

Tick to confirm each statement:
How did you locate this form? *

Readiness to Change

Help us understand your motivation and readiness

Motivated to lose weight? *
Motivated to change eating habits? *
Motivated to increase physical activity? *
Motivated to try new strategies/techniques? *
Confidence to devote time & effort now – next few months? *
Confidence to record intake & activity for 2–4 weeks? *
Satisfaction if 10% weight loss improves health & quality of life? *

Ready to Submit Your Consultation?

Review your information and submit for professional assessment

Your information is secure and will be reviewed by our UK registered pharmacist