Wegovy Assessment

Wegovy Weight Loss Assessment

This assessment is essential to ensure that Wegovy is a safe and suitable weight loss treatment for you. Please provide honest and accurate answers about your health, medical history, and any current medications. This allows our healthcare professionals to assess your eligibility and recommend the best treatment for your needs.

If your preferred treatment isn’t suitable, our clinicians can recommend an alternative weight loss option.

Ordered From Us Before?

If you’ve ordered from us before, you can reorder with fewer steps as we already have your details on file. Log in to your account before starting to save time on your assessment.

Good To Know

Your consultation will take around 5 minutes to complete
Our pharmacists will need to confirm your details with a quick video call
Your responses are 100% confidential and securely stored.

Please Confirm The Following:

I confirm that all the information I provide is honest and accurate to the best of my knowledge. I understand that Wegovy is a prescription medication, and my responses will determine whether it is safe and suitable for me. I understand that if I do not provide honest information, the pharmacists will be unable to complete a suitable assessment of potential side effects, risks, and the overall suitability of this treatment.

I agree to the Terms & Conditions and Privacy Policy of this service.

1. About You

What Is Your Full Name?

Please provide your full name as it is on your legal documents so we can verify your identity accurately.

Please Enter your Date of Birth

Age

You must be over 18 years old to purchase Mounjaro.

What Was Your Registered Sex At Birth?

We ask this because a range of health issues are specific to people based on their sex at birth.

Male

Female

Please Enter Your Current Height

We need this so we can calculate your body mass index (BMI) accurately. Please ensure that you add the correct figures as any false or inaccurate information may lead to severe illness and serious harm.

Height cm

Height Ft

Height inches

Please Enter Your Current Weight

lbs

Current Weight kg

Current Weight lbs

lbs

Your BMI

What is your ethnicity?

This will help our prescribers gain a better idea about your risk in relation to your weight.

Are you currently taking or previously had weight loss injections?

Yes

Additional Weight Loss Injections Information

Have you taken these in the last 4 weeks?

Yes

Additional Weight Loss Injections Information

Based on your selection, we are unable to prescribe Wegovy for you as it may not be safe or suitable for your condition. If you would like to discuss alternative weight loss treatments, please contact our team

Have you ever had an eating disorder?

For example, bulimia or anorexia.

Yes

Wegovy is not suitable for those who have or have had an eating disorder.

Are you currently pregnant, breastfeeding, or trying to get pregnant?

Yes

Wegovy is not suitable for women who are pregnant, breastfeeding, or trying to get pregnant

Have you been diagnosed with any other health condition(s)?

This could be current or past condition.

Yes

Any other health conditions info

Do you currently take any medication, or have you recently finished a course of medication, that you haven't mentioned already?

This includes medication you take occasionally or in emergencies.

Yes

Any other medication info

Are you allergic to any medicines or other substances?

Yes

Any other allergies info

Which GP Surgery Are You Registered At?

GP Surgery Address

GP Surgery Postcode

2. Your Details

Please enter an email address for your account

Please enter a phone number for your video call verification

Our pharmacists will need to complete a quick video call to confirm your details before approving your treatment. This is a legal requirement for safety and compliance. Please have a copy of your ID to hand during the call for verification

Do you have a preferred time we can reach you?

Please provide multiple date and time options that work for you in case our pharmacists are unavailable at your preferred time.

Treatment consent & declarations

I confirm that I am 18 or over and this treatment is for my sole use. I have answered all questions honestly and understand this is a non-emergency online service. I understand that the prescriber relies on my answers and that inaccurate information could pose health risks. I consent to the pharmacy sharing my consultation with my GP and, if needed, checking my NHS Summary Care Record to ensure safe prescribing. I will read the Patient Information Leaflet before use and will inform the pharmacy and/or my GP of any side-effects, new medicines, or changes to my health during treatment. I understand payment is taken on submission and that approval is not guaranteed; if I am unsuitable for treatment, I will receive a full refund.

Safety acknowledgement – GLP-1 weight-loss medicines

I understand and accept the following:

GLP-1 injectables (e.g. Mounjaro, Wegovy) can reduce the effectiveness of oral contraceptives; I will use additional non-oral contraception (e.g. condoms) during treatment.
Do not use alongside other weight-loss treatments.
Stay well hydrated.
Seek medical advice urgently if I develop severe abdominal pain (risk of pancreatitis/gallbladder problems).
Stop treatment and speak to a doctor if I notice neck lumps, a hoarse voice or throat changes.
Stop treatment and seek advice if I experience mood changes or low mood.
Do not use if pregnant or trying to conceive; stop at least 2 months before trying for a child.

Wegovy Weight Loss Assessment

Ordered From Us Before?

Good To Know

1. About You

2. Your Details

3. Choose Treatment Plan