Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.12345678910Do you agree and consent to the following? *YesI 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.NextAre you currently using weight loss medication?YesNoNextWhat medication did you last use?Wegovy/OzempicMounjaroSaxendaOtherPreviousNextWhat was the last dose you were prescribed?Wegovy 0.25mgWegovy 0.5mgWegovy 1mgWegovy 1.7mgWegovy 2.4mgPreviousNextWhat was the last dose you were prescribed?Mounjaro 2.5mgMounjaro 5mgMounjaro 7.5mgMounjaro 10mgMounjaro 12.5mgMounjaro 15mgPreviousNextPlease confirm the last dose you took0.6mg per day1.2mg per day1.8mg per day2.4mg per day3mg per dayPreviousNextWhen did you last use your medication?Less than TWO weeksBetween TWO and FOUR weeksMore than FOUR weeksNextWhen did you last use your medication?Less than three daysMore than three days currently What last PreviousNextWhat are your main reasons for wanting to lose weight? (copy)Improving my overall healthAvoiding or managing a specific health conditionLooking and feeling betterBecoming more activeImproving my mood or mental wellbeingImproving my sleep or energy levelsOtherNextWhat is your height?What is your Weight?Submit