Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 3I am over 18 years old and live in the UK. I will be the sole user of any medication offered to me through this service. I confirm all answers are provided by me, and are completely truthful. *YesName *FirstLastDate Of BirthNextAbout Your HealthAre you currently taking weight loss medication?YesNoDo you have Type 2 Diabetes?YesNoHave you been diagnosed with any thyroid disorders, including medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)?YesNoDo you have a history of pancreatitis?YesNoAre you currently pregnant, planning to become pregnant, or breastfeeding?YesNoDo you have any kidney or liver conditions?YesNo any syndrome been Have you experienced severe gastrointestinal disorders, such as gastroparesis?YesNoDropdownFirst ChoiceSecond ChoiceThird ChoiceDo you have any allergies to medications or food?YesNoIf yes, please clarify allergies Are you currently taking any medications, including over-the-counter, herbal, or supplements?YesNoIf yes please list which medications are you taking?NextUnderstanding Weight Loss Injections I understand that weight loss injections are a prescription medication used to assist in weight management. Possible side effects may include: Nausea, vomiting, or diarrhea Risk of pancreatitis Hypoglycemia when combined with other diabetes medications Thyroid tumors in animal studies (potential risk in humans) Gallbladder issues Changes in appetite Confirm Consultation
