Weight Loss > Weight Loss Consultation

Weight Loss Consultation

Patient Details

Provide these details to confirm and contact you about your consultation. Required for safe prescribing.

Full Name(Required)

Enter your full legal name.

Date of Birth(Required)

DD slash MM slash YYYY

Your date of birth is required to verify you are over 18 and eligible for treatment.

Email Address(Required)

We will use this to send updates and your payment link if approved.

Phone Number(Required)

We may contact you to complete your consultation and confirm any details.

Address(Required)

Street Address Address Line 2 City Post Code

Height, Weight, BMI

These measurements help assess eligibility for treatment.

Height(Required)

Centimetres

Weight(Required)

BMI(Required)

Please Note

How assessment works

Your details are reviewed by a clinician. Treatment is only supplied if appropriate.

Warning — Please Read

Additional review required

Your BMI may require additional eligibility checks during clinical review.

Warning — Please Read

May not be eligible

Your BMI appears below the eligibility threshold for weight loss medication. A clinician will review your request and advise alternatives if needed.

Medical Safety

These questions ensure treatment is safe and appropriate.

Are you pregnant, trying to conceive, or breastfeeding(Required)

Yes

Not applicable

This affects treatment eligibility.

Warning — Cannot Continue

Not suitable at this time

Weight loss medication is not suitable during pregnancy or breastfeeding. Please speak to your GP.

Do you have any medication allergies(Required)

Yes

List your allergies(Required)

Please list allergies for safety assessment.

Are you taking any medication(Required)

Yes

List your medication and dose(Required)

Please list medication and doses to check interactions.

Have you previously used weight loss medication?(Required)

Yes

Which medication have you used?(Required)

Did you experience any side effects or issues?

Do you have any serious medical conditions that may affect treatment?(Required)

Yes

Include any conditions such as digestive issues, pancreatitis, or thyroid conditions.

Do you have a history of an eating disorder(Required)

Yes

Important for treatment suitability.

Warning — Please Read

Specialist support required

Weight loss medication may not be suitable if you have an eating disorder history. A clinician will review and may advise GP support.

Relevant Health Conditions

Do you have any of the following?(Required)

Type 2 diabetes

Prediabetes

High blood pressure

High cholesterol

Sleep apnoea

Cardiovascular disease

None of the above

Clinical Photograph for Assessment

Upload a Recent Full Length Photograph

Drop files here or

Accepted file types: jpg, jpeg, png, Max. file size: 20 MB, Max. files: 2.

Clinical photographs support identity verification and safe remote prescribing assessment.

GP Details and Consent

GP Practice Name

Enter the name of your GP surgery if known.

GP Practice Postcode

Enter the postcode of your GP surgery if known.

Consent to contact my GP if needed(Required)

Yes

I consent to the pharmacy contacting my GP practice if needed to support my consultation or treatment review.

Warning — Please Read

GP notification recommended

We recommend informing your GP for continuity of care. A clinician may discuss this with you.

Declarations

Pharmacist Clinical Review(Required)

I understand my consultation will be reviewed by a pharmacist

I understand my consultation must be reviewed and approved by a pharmacist before any treatment can be supplied.

Information Accuracy(Required)

I confirm my information is accurate

Please ensure all details are correct before submitting. Providing incorrect information may affect treatment eligibility.

Weight Loss Consultation Consent(Required)

I consent to this consultation

I consent to the pharmacy reviewing my information to assess whether treatment is appropriate and safe to supply.

I agree to the Privacy Policy

Please review how we collect, use and protect your personal data.

CAPTCHA

What to expect

Complete this consultation so our pharmacist can review your details and confirm whether treatment is safe and appropriate.

Confirmation email sent after submission
Reviewed by our pharmacist
Outcome and next steps sent by email

Next steps

Complete the weight loss consultation

Check your email for confirmation

Our pharmacist reviews your details

We email the outcome and next steps

Weight Loss Consultation

Patient Details

Height, Weight, BMI

How assessment works

Additional review required

May not be eligible

Medical Safety

Not suitable at this time

Specialist support required

Relevant Health Conditions

Clinical Photograph for Assessment

GP Details and Consent

GP notification recommended

Declarations

What to expect

Next steps

Important information

Regulatory details