Online Consultation For Saxenda weight loss Programme

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Saxenda 6mg/ML Box 3 Pens - Delivered in 24 hours

Special Next Day Delivery Included In Price.

How long do you want to follow the programme?

One Pen £90

Two pens £170

Three Pens £250

Full name including surname

Date of birth

Female or Male

What is your blood pressure?

Normal (between 90/60 mmHg and 140/90 mmHg)

High (above 140/90 mmHg)

I do not know

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When was the last time your blood pressure was checked?

- Less than one year ago

- More than one year ago

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What is your BMI

What is your height and weight?

Do you have or have you ever had any of the following conditions?

Cardiovascular diseases (hypertension, AF, heart attack, angina)

Epilepsy or seizures

Any form of cancer

Diabetes

Gallstones or gallbladder disease

Liver problems

Kidney problems

Underactive thyroid

Overactive thyroid

Pancreatitis

HIV

Chronic malabsorption syndrome

Mental disorders (depression, bipolar disorder or suicidal thoughts)

Brain damage

A drug or alcohol problem

Heart failure

None of the above

Have you ever had any of the following conditions?

Bulimia

Anorexia

Physical dysmorphic disorder

I have or have had an eating disorder before, but it is not in the list above

No, I have never had any of the above problems

How many calories do you think you take in a day?

Less than 500

Between 500 and 1500

More than 2000

It is not safe to buy, and use, weight loss treatments from more than one supplier at the same time as this can endanger your health.

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If you are overweight but not obese, and you are prescribed treatment to lose weight, this treatment may be used off-label. This means that the drug is prescribed for a purpose for which it was not originally approved by the drug authorities.
"Off-label" use refers to prescribing a drug for an indication other than that for which it was approved by the relevant authority. While it can still be safe, it is crucial that you are fully informed about the off-label use of the prescribed medicine and that you consent to it.

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It is important that you inform your GP that you are receiving this treatment from us.
When we send your treatment, we will also send you a letter from us addressed to your GP, with details of the treatment we have recommended for you. It is your responsibility to pass this on to them so that they can ensure good continuity of care for you.

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If any of the aspects below apply to you, we would like to hear from you.

- I have one or more medical conditions
- I have had surgery before
- I take medicine(s)
- I have one or more allergies
- I smoke or have smoked in the past
- I drink alcohol
- I have one or more medical conditions
- I have one or more close relatives
- I use recreational drugs

- I am trying to conceive

- I am breastfeeding

- I am pregnant

I declare everything in truth

YES

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1 of our doctors will review and assess your profile

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E-mail address for the receipt and saxenda instructions

Address details

Telephone number

All information is confidential

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I declare this meditation is for personal use and not for resale.

YES

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Saxenda user manual

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