Start Your Consultation

Complete our online assessment to begin your weight loss journey

Consultation Progress

0% complete
Share securely

Invite someone you trust to start their journey

Send the consultation link to family, friends, or colleagues who may benefit from pharmacist-led care. We’ll take care of the rest with the same discreet, professional approach.

  • NHS-trained pharmacists review every submission

    No shortcuts, no algorithms – real clinicians only.

  • Secure link with TLS encryption

    The recipient can complete the form on any modern device.

Share toolkit

Secure

1

About You

Tell us about yourself to get started

Gender *

Enter kg (auto-fills st/lbs)

2

About Your Health

Help us understand your medical history

2.1 Do you suffer from any heart problems? *
2.2 Do you have any thyroid problems? *
2.3 Thyroid cancer in you or immediate family? *
2.4 Pancreatitis (current or past)? *
2.5 Kidney problems? *
2.6 Liver problems? *
2.7 Severe gastro-intestinal problems? *
2.8 Diabetes? *
2.9 Mental health problems? *
2.10 Eating disorder? *
2.11 Other medical problems? *
2.12 Other medication not already identified? *
2.13 Known allergies? *
2.14 Permission to inform your GP? *
3

About Your Lifestyle

Tell us about your daily habits and routines

3.1 Do you smoke? *
3.2 Do you drink alcohol? *

Excessive alcohol can increase health risks. For support cutting down, visit this page.

Staying hydrated helps reduce constipation.

Poor sleep affects hunger hormones.

NB: 150 min moderate or 75 min vigorous recommended.

4

Your Weight-Loss Journey

Tell us about your weight loss experiences and goals

4.3 What contributes to your excess weight? *
4.5 Currently taking any treatments (Mysimba, Saxenda, Ozempic, Phentermine)? *
5

Declaration & Consent to Treatment

Please review and agree to the terms and conditions

5.1 Tick to confirm each statement:
5.2 How did you locate this form? *
6

Readiness to Change

Help us understand your motivation and readiness

6.1 Motivated to lose weight? *
6.2 Motivated to change eating habits? *
6.3 Motivated to increase physical activity? *
6.4 Motivated to try new strategies/techniques? *
6.5 Confidence to devote time & effort now – next few months? *
6.6 Confidence to record intake & activity for 2–4 weeks? *
6.7 Satisfaction if 10% weight loss improves health & quality of life? *

By submitting, you agree the information provided is accurate to the best of your knowledge.