• Start your Weight Loss medication prescription request in minutes

  • This is a preliminary questionnaire to help us assess your suitability for treatment. You will be asked to complete a more detailed questionnaire at a later stage.

  • Can we connect you by telephone?*

  • What is your current height and weight? We need this to calculate your Body Mass Index (BMI).

  • BMI must be over 27 (excluding patients currently on injections)*
  • Which is your preferred choice of medication?*
  • Are you currently taking medication to lose weight?*
  • Have you had weight-loss surgery?*
  • Do you have, or have you ever had, diabetes?*

  • **Our service may not be able to prescribe weight loss injections for you.

  • Do you have, or have you ever had, pancreatitis? Pancreatitis is a condition where the pancreas becomes inflamed (swollen). The most common symptoms of acute pancreatitis include: sudden severe pain in the centre of your tummy (abdomen), feeling or being sick, diarrhoea and a high temperature.*

  • **Our service may not be able to prescribe weight loss injections for you.

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  • Unsuccessful completion

    For patients who have not managed to complete the questionnaire, we are unable to offer this service. Some people may still be eligible after investigations or discussion with your GP or specialist team. To arrange this, you will need to attend an initial outpatient consultation with our lead consultant surgeon, Mr Sanjay Agrawal. He will also discuss other possible weight loss options available to you including bariatric surgery.

    If you book through our website, an assessment appointment costs £100 (virtual or face to face at a private hospital in London, Essex and Hertfordshire). **A 50% saving off usual consultation. 

    Please note

    • We cannot offer medication if your BMI is below 27.
    • Unfortunately, if you have had pancreatitis or have diabetes which requires medication, we are unable to offer you medication

    Yours truly,
    Clinical Team
    Harley Street Obesity Clinic

  • Click Submit button below

    Successful completion

    Thank you for completing the pre screening questionnaire. If your replies are suitable for medication, you will shortly receive a link to complete the full health questionnaire.

    Once this is received you will be invited to a zoom consultation with a specialist nurse or dietitian. You will have the chance to ask any questions or express concerns.

    Following this we ask you to upload ID information, sign the consent form and (if BMI under 32) sent a weight/height slip. Following payment your prescription will be sent to an online pharmacy and sent to you. Please do a final check of your address, email and telephone number because this will be used by the pharmacy.

    Yours truly,
    Clinical Team
    Harley Street Obesity Clinic

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