Am I Eligible?

Am I Eligible?

Mounjaro® is a prescription medication and is only provided to eligible clients. These questions help us make sure it's safe to prescribe. It'll take less than 60 seconds!
What is Your Weight & Height?*
10st=140lbs  11st=154lbs

12st=168lbs  13st=182lbs

14st=196lbs  15st=210lbs

16st=224lbs  17st=238lbs

18st=252lbs  19st=266lbs

20st=280lbs  21st=294lbs
BMI*
Enter Your BMI Calculated Above

Do any of the following apply to you?*

Type 1 DiabetesPersonal or Family History of Thyroid CancerHistory of PancreatitisHistory of an Eating DisorderSevere Liver or Kidney ProblemsSevere Gastrointestinal Problems (Crohn's, Ulcerative Colitis, Gastroparesis)Currently Pregnant or BreastfeedingI am under the age of 18NONE of the Above

Name*

First NameLast Name
Email*
example@example.com
I consent to joining Doctor Parke's mailing list for useful weight loss advice and programme updates*

YesNo
Should be Empty: