What is your height and weight?

Let's see if you are eligible?
What is your target weight in kgs (Goal)

What is your height and weight?
Height (cm)*
Weight (kg)*
BMI
Your BMI is: {bmi9}
BMI: Low

Underweight Range
BMI: Normal

Normal and Healthy Weight Range
BMI: High

Overweight Range
BMI: Very High

Obese Range

Which of the following strategies have you tried to lose weight? Images + multiple choice 2x3 display

Exercise or being more activeIntermittent fastingDietingWeight loss plansCalorie countingI haven't tried to lose weight

What challenges have you faced when changing your eating habits?

I get hungryI get cravingsI snack a lotI eat too much when I’m stressedI swing between being disciplined and binge eatingI’m not sure what I should be eating

What challenges have you faced with exercise or trying to be more active?

I do not have enough timeI lose motivationInjury / illness makes it difficultI’m not sure what I should be eating

What challenges have you faced with exercise or trying to be more active?

I do not have enough timeI lose motivationInjury / illness makes it difficultI do not find it enjoyableI feel uncomfortable exercising in front of othersI haven’t tried to be more active

How long have you found it difficult to manage your weight alongside diet and lifestyle measures?

Last 12 monthsLast 5 yearsLast 10 yearsType option 4Most of my lifeI’ve never struggled with my weight

What are your main reasons for wanting to lose weight? (Select all that apply)

Improving my mood that is linked to weightImproving my sleep or energy levelsImproving my overall healthAvoiding or managing a specific health conditionLooking and feeling betterBecoming more active

Congratulations! You’re suitable for the Trim weight loss programme. Enter your email to complete the final steps.
Full Name

Fist NameLast Name
Email

Fail

Thank you for registering your interest! Unfortunately, we’ve noticed there may be an issue with you starting our weight loss plan. Please contact our medical team for more information.

Part 2 - Medical
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Date of birth

MonthDayYear
Ethnicity
Gender assigned at birth
Are you pregnant, breastfeeding or trying to conceive?

YesNo

Do any of the following statements apply to you in the past 3 months? (Choose as many as you like)

You think you are overweight when others say you are too thinYou severely restrict your food intake to control your weight/shapeYou regularly exercise excessively or to exhaustion as a means to control your weightYou have taken laxatives or diuretics to reduce or manage your weightYou sometimes make yourself sick after eating because you felt fullNone of the above

Do you suffer, or have you previously suffered, from an eating disorder? (This can include, but is not limited to, the following: anorexia nervosa, bulimia, binge eating disorder)

YesNo

Do you have any allergies?

Semaglutide (Wegovy, Ozempic, Rybelsus)Tirzepatide (Mounjaro)SaxendaTrulicityVictozaExcipients (Propylene glycol, Phenol, Disodium phosphate)NoneOther

Do you live with any of the following mental health conditions?

Depression or anxietyPTSDOCDSchizophrenia or psychosisBipolar disorderNone of the aboveOther

Have you: Been treated in a psychiatric hospital in the past 12 months?, Engaged in deliberate self harm or attempted suicide in the past 12 months?, Been sectioned for your mental health in the past 5 years?

YesNo

If there is anything else you would like to share with our prescriber please type this here. Please can you also include ALL medical conditions you have or have had in the past (including anything you may have selected in previous questions) and any other important details that you feel have not been covered in the consultation thus far. This could include recent surgery, medical conditions not mentioned, or anything else relevant about your medical history.
Do you consider yourself vulnerable and require additional support?

YesNo

Please enter your GP’s details:
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
To ensure the safety of every patient, we require consent to access your summary care records (SCR), or share consultation and prescription data with your GP.
Do you consent ?

YesNo
To receive medicine from us, do you agree to all of the below?
• I will watch the user guide video (QR code on shipping box)
• I will read the patient information leaflet prior to self-administering the medicine.
• I will safely store and dispose of used sharps (Bin included in shipping box)
• I will use this medicine alongside diet & lifestyle improvements.
• If I experience any sudden changes to my mood, behaviour or thoughts whilst taking this medicine (Eg. Suicidial thoughts) I will stop treatment and seek medical advice immediately.
• If I accidentally overdose, I will seek medical assistance immediately.
• I have read the Pharmacy terms (xomedical.co.uk) and understand all orders are non-cancellable and non-refundable, unless the pharmacy is unable to approve your prescription. Any references to “we” or “us” refers to XO Medical Ltd (our pharmacy/prescribing platform).
To proceed, do you agree and consent to the following?
• I am over 18 years old and live in the UK.
• I confirm all answers are provided by myself, and are completely honest and true.
• I will be the sole user of this service, of my own free will, and any medicine obtained is for my personal use only.

Congratulations! You’re suitable for the Trim weight loss programme. Click ‘Next’ to start your journey.

Weight loss medication

Our medical team recommends commencing GLP-1 medicine. Studies have shown that 85% of people lost 5% of their body weight, with results up to 15% body weight*
Should be Empty:

Let's see if you are eligible?

What is your height and weight?

Fail

Part 2 - Medical

Please enter your GP’s details:

To ensure the safety of every patient, we require consent to access your summary care records (SCR), or share consultation and prescription data with your GP.

To receive medicine from us, do you agree to all of the below?

Congratulations! You’re suitable for the Trim weight loss programme. Click ‘Next’ to start your journey.

Weight loss medication