Weight Loss - Checkout Page

Please answer a few medical questions from our practitioner to prescribe your medication.

Please note: If you need urgent assistance, do not use this service. Call 111, or in an emergency call 999.

Are you a male or female?
(Biological assigned gender at birth)

Male Female

What is your height?

What is your weight?

What is your blood pressure?

What is your date of birth?

Do you smoke?

Yes No

How many cigarettes do you smoke per day?

Have you had any cardiovascular(heart) problems or have you ever had a stroke?

Yes No

Can you walk 3 miles without pain in your chest?

Yes No

Do you suffer from any allergies?

Yes No

Please detail any allergies that you may have.

Are you currently taking any other medication, or have recently finished a course of medication?

Yes No

Medication name

Strength
(e.g. 100mg. If unsure, type: 'I'm not sure'.)

How many do you take a day?
(e.g. 1 tablet twice a day)

Select file / image

Is there a history of any disorder that has run within your family?

Yes No

Please provide more information, including as much detail as possible.

Have you ever had any major surgery?

Yes No

Please provide more information, including as much detail as possible.

Do you believe you have the mental capacity to make decisions about your own healthcare?

No Yes

You have selected you do NOT have mental capacity to make decisions about your own healthcare please provide further information, including as much details as possible

What is your ethnicity?

Do you agree to give consent for PrescriptionDoctor.com’s prescribers and/or pharmacist to access your summary care record (SCR)?

Yes No

Your Treatment

Are you currently registered with a UK GP practice?

Yes No

Due to government regulations issued by the General Pharmaceutical Council, all online prescribing services now require you to confirm your GPs details so that they can be informed of your treatment. By doing so, we can make sure you're receiving the best level of care while also giving you a service that's safe, reliable and tailored to your needs.

Search for your GP by entering a postcode (yours or theirs).

Can you tell us why you are not currently registered with a GP, or why you're unsure? This consultation requires us to share this treatment with your GP.

I've only recently moved to the UK I've been removed from my practice list and not had a chance to register elsewhere Other

Do you agree that you have answered all of the above questions accurately and truthfully. You understand our prescribers will prescribe medication based on your responses, any incorrect responses or deliberate acts to misinform may be hazardous to your health. You are happy for your consultation to be reviewed by a Pharmacist Independent prescriber.

I agree

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Repeat Email:

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Billing Address

Alert!
Please enter your billing address. This is the one which is linked to your bank account and allows us to complete your ID check.

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Address Line 1:

Address Line 2:

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Postal code:

City:

My delivery address is the same as my billing address

Delivery Address

Delivery Address:

Address Line 1:

Address Line 2:

Address Line 3:

Postal code:

City:

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Please answer a few medical questions from our practitioner to prescribe your medication.

Your Treatment

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Enter name, email and phone number.

How We Are Regulated

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Please answer a few medical questions from our practitioner to prescribe your medication.

Your Treatment

Fill out your personal details.

Enter name, email and phone number.

Welcome Back!

Forgot your password?

How We Are Regulated

Payment Options