Your Height & Weight

About you

These questions help us ensure treatment is right and safe for you (select all that apply).

If you have Type 2 Diabetes, do you take any medication to manage blood sugar?

Have you experienced an allergic reaction to Wegovy, Mounjaro, semaglutide, tirzepatide, Saxenda or liraglutide before?

Have you ever suffered from an eating disorder such as anorexia nervosa or bulimia?

Are you pregnant, breastfeeding, or trying to conceive?

Have you been diagnosed with or had surgery for any of the following?

• Acromegaly or any growth hormone problem
• Chronic malabsorption syndrome
• Cushing's syndrome
• Gallbladder or bile duct issues
• Gastric (bariatric) surgery within the last 12 months
• Heart failure
• Hypoglycaemia
• Chronic kidney disease (stage 4 or higher)
• Liver disease
• Pancreatitis
• Type 1 diabetes
• History of gastroparesis
• Current cancer diagnosis / treatment (last 12 months)

Have you suffered from severe gastrointestinal disease (e.g. inflammatory bowel disease, ulcerative colitis, Crohn's disease)?

Do you have a personal or family history of medullary thyroid cancer, thyroid cancer or MEN2 syndrome?

Are you currently taking any other medication, herbal or recreational drugs?

Are you currently taking steroids or medication to treat your thyroid?

Are you currently using any of the following weight loss medications (injected in the last 4 weeks)?

Do you understand that Mounjaro may reduce the effectiveness of oral contraceptives and that you must use additional non-oral methods during treatment?

Do you understand that this medication should not be used by people trying to conceive or within two months of trying to conceive?

Do you understand there may be increased risks (pancreatitis, gallbladder problems, gastroparesis) and to seek medical advice if you have abdominal pain whilst using this medication?

Your Details & Consent