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9 Burwash Road, Hove, Boston, BN3 8GP
If you have ordered this medication before, you can log in to fill up the questionnaire automatically. Our pharmacists have a few quick and easy questions to help issue your FREE online prescription
If you are a new Online Doctor patient, please complete the following questions to help us better understand and treat your condition. It's very similar to visiting a GP but without leaving home. Our Doctors will then review your responses and confirm approval of your treatment. If we can't prescribe you a treatment, no payment is taken and we'll do our best to suggest alternative options.
Do you suffer from any heart problems? (e.g. high or low blood pressure, previous heart attacks, angina, irregular heart rhythm)
What is your blood pressure?
Do you suffer from any breating problems? (e.g. asthma, COPD, bronchiectasis)
Do you suffer from any kidney problems?
Do you suffer from any liver problems? e.g. hepatitis, fatty liver, alcohol liver disease
Do you suffer from any hormone or sugar problems? (e.g. diabetes, thyroid problems)
Do you suffer from any mental health problems? (e.g. anxiety, depression, personality disorder)
Do you suffer from any neurological problems? (e.g. parkinsons, previous stroke or mini-stroke)
Please tell us about any operations you have had
Do you suffer from any other medical problems?
What is your height?
What is your weight?
Are you currently taking any medications?
Do you smoke?
Do you drink alcohol?
Do you suffer from any allergies?
Is there a history of any disorder that runs in the family?
Are you, or could you be pregnant?
Are you trying to become pregnant?
Are you breastfeeding?
Have you previously or are you currently taking any weight loss treatments? (e.g. Xenical, Alli or Phentermine)
Have you purchased other weight loss medications either in stores or on the internet?
How else have you tried to lose weight? (e.g. Consulted your GP, exercise or diet)
Are you currently withdrawing from alcohol or benzodiazepines? (e.g. diazepam)
Are you taking or have you taken any painkillers in the last 3 months?
How many calories a day do you think you consume?
Do you regularly eat take away food? (e.g. Pizza, burgers, fried chicken)
Do you regularly eat crisps/chocolates/cakes?
How much exercise do you do each week?
Have you ever suffered from an eating disorder? (such as Anorexia Nervosa or Bulimia)
Have you been diagnosed by your doctor as suffering from any of the following conditions?
High blood pressure?
Please select date when you were diagnosed
Type 2 diabetes?
Dyslipidemia? (such as high cholesterol or high triglycerides in the blood)
Please tell us anything else that may be important to this consultation
Have a question? call us now
Need support? Drop us an email
Mon – Fri
09:00 – 18:00
09:00 – 13:00