Check your eligibility

Weight loss isn’t one size fits all

⁠We’ll now ask you a few questions to assess your eligibility and personalise your treatment.

⁠⁠Your responses will be kept private and confidential.

Do you agree and consent to the following (Required)

  • I am over 18 years old and live in the UK.
  • I will be the sole user of any medication offered to me through this service.
  • I confirm all answers are provided by me, and are completely truthful.

Name (Required)

Contact Information

Medical History

Do you have any of the following chronic health conditions? (Required)

Do you have a history of any of the following? (Required)

Are you currently pregnant, planning to become pregnant, or breastfeeding? (Required)

Please be aware (Required)

  • These medications are not suitable in pregnancy or if you are trying to conceive.
  • If you are sexually active, we advise contraception when taking this medication.
  • This should be a non-oral contraception (e.g. condoms or the coil) if using Mounjaro or Orlistat.
  • If you're taking oral contraceptives, you will need to take an additional form of contraception during treatment, due to reduced absorption which can result in oral contraceptives being ineffective.

Current Medications and Supplements

Have you previously used any weight loss medications or treatments? If so, please specify which ones and your experience with them. (Required)

Are you currently taking any other GLP-1 receptor agonists (e.g., semaglutide) or insulin? (Required)

Which product and doeses are you using now: (Required)

Have you previously tried any of the following methods to lose weight? (Required)

What is your primary goal with Mounjaro/Wegovy? (Required)

Dietary and Exercise Habits

How would you describe your current diet? (Required)

Do you currently exercise? (Required)

Risk Assessment

Do you have a family history of thyroid cancer, pancreatitis, or MEN2 syndrome? (Required)

Do you currently experience any of the following symptoms? (Required)

Expectations and Goals: What are your primary motivations for starting Mounjaro/Wegovy? (Required)