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Weight Management  Consultation

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(must match billing name)

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feet, inch, cm

cm
Value must be between 100cm and 220cm
Switch to ft, in
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st, lb, kg

kg
Value must be between 40kg and 250kg
Switch to st, lb
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e.g. Box with your name on label from any provider, online record screenshot including medication details, copy of your prescription etc.  Please ensure that the strength of the pen is visible in the evidence provided.

Drag and drop an image or click to browse
Supported formats: JPG, PNG
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Weight-loss medications such as Mounjaro or Wegovy should not be used during pregnancy or breastfeeding and must be stopped at least two months before trying to conceive.

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If you are taking weight loss injections while using oral contraception, it is advised to use a non-oral method—such as the implant, coil, or condoms—for added protection.

If you are taking weight loss injections while using oral contraception, it is advised to use a non-oral method—such as the implant, coil, or condoms—for added protection.

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Enter GP details Manually or search via GP postcode/name.

I agree that the information I have provided is correct and I give consent to Dr Weightmans Pharmacy to verify this information with my SCR (Summary Care Records) if required.
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