Mounjaro Assessment

Weight Loss Assessment

This assessment is essential to ensure that Mounjaro 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
You’ll need to upload two images to verify your identity and weight
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 Mounjaro 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

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 inches

inches

Please Enter Your Current Weight

lbs

Current Weight KG

lbs

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

Do you have any of the following conditions?

Asthma

Chronic Back Pain

Depression linked to weight

Erectile Dysfunction

Fatty liver disease

High blood pressure (hypertension)

High cholesterol

Osteoarthritis

PCOS

Type 2 diabetes / Pre-diabetes / insulin-resistance

Obstructive sleep apnoea (OSA)

None of the above

Additional Weight Loss Injections Information

Have you been diagnosed with any of the following?

Chronic Kidney Disease (CKD), polycystic kidneys or kidney failure

Severe heart failure

Kidney impairment

Type 1 diabetes or Diabetic Retinopathy

Pancreatitis (current or previous)

Gastroparesis or inflammatory bowel disease

Ulcerative colitis or Crohn’s disease

History or family history of Thyroid, medullary thyroid cancer, or MEN2

Cushing’s Syndrome

Any cancer, current chemotherapy or radiotherapy

None of the above

Based on your selection, we are unable to prescribe Mounjaro 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. If you think you may have an eating disorder, but have never been diagnosed, please select ‘yes’.

Yes

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

Yes

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

This could be current or past condition.

Yes

Additional Weight Loss Injections Information

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

Are you allergic to any medicines or other substances?

Yes

Which GP Surgery Are You Registered At?

GP Surgery Address

GP Surgery Postcode

2. Upload Documents

Please upload a photo ID

Please upload a clear photo of one of the following: Passport, Driving licence, or Photographic ID card showing your name clearly.

Choose File

Please upload a current picture of you

This must show you facing the front and include your face and body (head to toe). This is a legal requirement to ensure we are meeting standards for supplying weight loss medication and to help our pharmacists prescribe safely.

Choose File

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.

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.

I confirm that I am over 18 and this treatment is for my sole use. I have answered all questions honestly and truthfully, and I understand that this is a non-emergency online service.

I understand that GLP-1 injectable weight-loss medications (such as Mounjaro and Wegovy) may reduce the effectiveness of oral contraceptives and that I must use additional non-oral contraception methods (e.g. condoms) during my treatment.

I agree to inform both this pharmacy and my GP about any treatment-related side effects, the initiation of new medication, or changes in my medical conditions during the course of treatment. I agree to read the Patient Information Leaflet provided with my medication before using my treatment. If I have any questions, I will contact the support team or my GP.

I acknowledge that my prescriber relies on my responses as truthful and honest when making prescribing decisions and that providing inaccurate information may result in serious health risks. I consent to the pharmacy sharing my consultation information with my GP and accessing my NHS Summary Care Record (SCR) if required to confirm any necessary details for safe prescribing.

I understand and accept the following medical risks and responsibilities:

There may be an increased risk of pancreatitis, gall bladder problems, and gallstones with this medication. If I experience any abdominal pain, I will seek medical advice.
Injectable weight loss medications should not be used alongside other weight loss treatments.
I must stay hydrated while using this medication.
If I develop lumps in my neck, a hoarse voice, or any throat abnormalities, I will stop taking the medication and speak to my doctor.
Weight loss treatments may be linked to changes in mood (including depression). If I experience low mood or depressive symptoms, I will stop the medication and seek medical advice.
This medication should not be used by men or women who are trying to conceive or are pregnant. I understand that I must stop treatment at least two months before trying for a child.

I acknowledge that once I submit this consultation form, my payment will be processed. However, I understand that this does not guarantee treatment approval. If I am deemed unsuitable for treatment, I will receive a full refund.

3. Choose Treatment Plan

Each Mounjaro pen comes pre-dosed with four injections (one per week).

You cannot mix different strengths in a single order—only one strength can be purchased at a time.

New starters must begin treatment at the lowest dose (2.5mg) before increasing to a higher strength.

If you are unsure which strength is right for you, our pharmacists will review your consultation and recommend the most appropriate option.

Choose Treatment

2.5mg - £149

5mg - £159

7.5mg - £179

10mg - £189

12.5mg - £209

15mg - £219

Unsure - £149

We will take an initial payment of £149 based on the lowest dose. However, depending on the outcome of your consultation, our healthcare team may determine that a higher dose is more suitable for you.

If a higher dose is recommended, you will be contacted to confirm your new dose and the updated price before proceeding.

If you are selecting a dose higher than 2.5mg, you must upload proof of a previous prescription, as all new starters are required to begin at the lowest dose. Acceptable proof includes a past prescription document or a pharmacy label showing your name and dosage. If you cannot provide this, you will need to start with the 2.5mg dose.

Please upload a valid prescription or proof of prior use

Choose File