Clone of Weight-Loss Eligibility

1

What's your age range?* This field is required.

Under 18

18-84

Over 84

2

Have you ever suffered from pancreatitis?* This field is required.

YESNO

3

Do you have any of the following medical conditions?* This field is required.Tick all that apply

Severe kidney impairment or end stage kidney disease

Severe liver disease

Severe congestive heart failure (NYHA class IV)

Diabetic retinopathy

History of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2

Severe gastroparesis

None of the above

4

Have you taken weight loss medication before* This field is required.

YESNO

5

Which weight loss medication did you take?* This field is required.

6

What's your height (cm)* This field is required.

7

What's your weight? (kg)* This field is required.

8

Your BMI* This field is required.

10

Which weight-loss medication are you interested in?* This field is required.

Mounjaro injections

Wegovy injections

Wegovy tablets

Not made my mind up yet

11

Unfortunately, you are not eligible for the weight loss treatment service

12

You are eligible for consideration for treatment with weight loss medication. Please now book a free consulation with the pharmacy team to confirm your treatment and dose.

Book now