Important Acknowledgements

Please read and acknowledge the following statements carefully.

I confirm that I am completing this consultation for myself and all information provided is accurate to the best of my knowledge.

I acknowledge that I must disclose all current prescription medications and commit to using only one weight loss treatment at any given time.

I understand that I must disclose all medical conditions, serious illnesses, and any operations I have undergone.

I confirm that I have read and agree to the Terms & Conditions, Terms of Sale, and Privacy Policy.

I understand that providing accurate and honest responses in this weight loss consultation questionnaire is essential. I acknowledge that withholding information or providing false details could lead to serious health risks, including life-threatening consequences. By completing this questionnaire, I confirm that all my responses are truthful and accurate.

Age Verification

Please confirm your age to proceed with the assessment.

About You

This assessment is crucial for your weight loss consultation. Please be honest with your answers.

It's really important you give us an accurate up-to-date measurement. You may be asked to provide evidence of your current weight.

Medical History

Medical Questions

Category 1: Clinical Contraindications and Cautions

Conditions that may contraindicate or require caution with certain medications or treatments, especially for weight management

Do any of the following statements apply to you?

Category 2: Relevant Medical Comorbidities

Conditions commonly associated with or contributing to obesity and requiring holistic management

Do any of the following statements apply to you?

Category 3: Psychosocial & Functional Impact

Factors influencing quality of life, motivation, and patient-reported outcomes

Do any of the following statements apply to you?

Other Medical Information

Our clinicians need to know your full medical history to make sure our weight loss plan is safe for you.

Weight Loss Medication History

Medical Questions

Eating Habits

Please answer these questions about your eating habits.

Medications and Exercise

Please provide information about your current medications and exercise routine.

Current Medications

Please include dosage and frequency if known.

Allergies

Recent Surgery

GP Notification

To ensure we provide the best and safest service for you, we strongly encourage you to share your GP details so we can inform them about your treatment.

Review Your Assessment

Please review your answers below. If you need to make changes, use the Previous button to go back and edit.