To help us understand that this treatment is the right option for you, please answer the following questions. If you get stuck or need any help, you can contact us.

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Male
Female
Transmale (Born a female)
Transfemale (Born a male)


To qualify, your BMI must be over 30, or between 27 and 30 if you have at least one weight-related comorbidity, such as prediabetes, diabetes, hypertension, dyslipidaemia, or obstructive sleep apnoea

Please select either Metric or Imperial measurements :

Metric (Centimetre and Kilograms)
Imperial (Feet and Pounds)



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- Thryoid issues

- Issues with absorbing food (such as chronic malabsorption)

- Rectal bleeding issues

- Eating disorders

- Cholestasis















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- I am between the ages of 18 and 75

- This treatment is for my use only

- I have the capacity to make decisions about my own healthcare

- I have understood all the questions and have answered this consultation truthfully and completely

- I understand the prescriber will use my answers and base their prescribing decisions accordingly, and that providing incorrect information could be harmful to my health

- I will read the patient information leaflet supplied with this medication

- I will contact we prescribe and inform my GP if I experience any side effects from this treatment or if there are any changes to my health

- I have read, understood and agree with our Terms and Conditions