Weight Loss and Obesity

Weight Loss and Obesity Consultation

What is your height?

What is your weight?

Have you ever previously attempted to lose weight by both diet and exercise?

Do you currently or have you previously used any medication to help you lose weight?

If so, please provide more information

Please provide more details

Do you currently suffer with any of the following conditions?

- High blood pressure - Diabetes - High cholestrol - Sleep apnoea

Please provide more details

How many calories do you intake on a usual day?

Have you ever previously been diagnosed or suffer with an eating disorder such as anorexia or bulimia?

If so, please provide more information

Please provide more details

Do you or have you ever previously suffered with any kidney or liver impairment or damage?

Have you ever previously been diagnosed with Atrial Fibrillation or any condition related to heart beat rhythm?

Have you ever previously been diagnosed with heart failure?

Do you or anybody in your family have any history of thyroid cancer, any previous thyroid issues or any endocrine issues?

Have you ever been diagnosed with any other medical conditions?

This can include: -Immune system conditions such as HIV -Liver or kidney issues

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Do you suffer with any allergies?

If so, please provide more information

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Do you currently take any medication? This includes herbal remedies and over the counter medication.

If so, please provide more information

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Are you currently pregnant, planning a pregnancy or breastfeeding?

Is there any other information you would like to share with our prescribing team?

If so, please provide more information

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We strongly recommend that you inform your GP of any treatment you receive. Would you like WePrescribe to do this on your behalf?

I have read and understood the Terms and Conditions.

Please see our terms and conditions here

Weight Loss and Obesity Consultation