If you have received weight loss medication from us more than 6 months ago, please answer the following questions to ensure that we continue to prescribe safely and that your treatment remains effective and right for you.

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Name*

First Last

Phone*

Email*

What date did you start treatment?*

What was your initial BMI and weight (in stones or kg) before beginning the treatment?*

What weight are you aiming to achieve?*

Are you satisfied with your progress so far?*

Have you experienced any changes in your mood or mental health since starting the medication?*

How has your sleep quality changed since you began the medication?*

Are there any activities you were unable to do before starting the treatment that you can now participate in?*

Are you experiencing any side effects that have affected your quality of life or caused you to miss a dose of the medication? If so, please provide details.*

Has there been any change in your medical history or health since starting the treatment?*

How have your diet and activity levels changed since you began the medication?*

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