Weight Loss - Medical Assistment

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

Step 1

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)

You must answer the question to continue
 

What is your blood pressure?

You must answer the question to continue
 

Do you suffer from any breating problems? (e.g. asthma, COPD, bronchiectasis)

You must answer the question to continue
 

Do you suffer from any kidney problems?

You must answer the question to continue
 

Do you suffer from any liver problems? e.g. hepatitis, fatty liver, alcohol liver disease

You must answer the question to continue
 

Do you suffer from any hormone or sugar problems? (e.g. diabetes, thyroid problems)

You must answer the question to continue
 

Do you suffer from any mental health problems? (e.g. anxiety, depression, personality disorder)

You must answer the question to continue
 

Do you suffer from any neurological problems? (e.g. parkinsons, previous stroke or mini-stroke)

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Please tell us about any operations you have had

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Do you suffer from any other medical problems?

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What is your height?

You must answer the question to continue
 

What is your weight?

You must answer the question to continue
 

Are you currently taking any medications?

You must answer the question to continue
 

Do you smoke?

You must answer the question to continue
 

Do you drink alcohol?

You must answer the question to continue
 

Do you suffer from any allergies?

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Is there a history of any disorder that runs in the family?

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Are you, or could you be pregnant?

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Are you trying to become pregnant?

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Are you breastfeeding?

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You must agree to continue
Step 2

Have you previously or are you currently taking any weight loss treatments? (e.g. Xenical, Alli or Phentermine)

You must answer the question to continue
 

Have you purchased other weight loss medications either in stores or on the internet?

You must answer the question to continue
 

How else have you tried to lose weight? (e.g. Consulted your GP, exercise or diet)

You must answer the question to continue
 

Are you currently withdrawing from alcohol or benzodiazepines? (e.g. diazepam)

You must answer the question to continue
 

Are you taking or have you taken any painkillers in the last 3 months?

You must answer the question to continue
 

How many calories a day do you think you consume?

You must answer the question to continue
 

Do you regularly eat take away food? (e.g. Pizza, burgers, fried chicken)

You must answer the question to continue
 

Do you regularly eat crisps/chocolates/cakes?

You must answer the question to continue
 

How much exercise do you do each week?

You must answer the question to continue
 

Have you ever suffered from an eating disorder? (such as Anorexia Nervosa or Bulimia)

You must answer the question to continue
 

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

You must answer the question to continue
 

Type 2 diabetes?

Please select date when you were diagnosed

You must answer the question to continue
 

Dyslipidemia? (such as high cholesterol or high triglycerides in the blood)

Please select date when you were diagnosed

You must answer the question to continue
 

Please tell us anything else that may be important to this consultation

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You must agree to continue
01273 204 905

Have a question? call us now

hello@burwashmedsdirect.co.uk

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Mon – Fri 09:00 – 18:00

Saturday 09:00 – 13:00

Sunday Closed