Weight Loss

Do you suffer from or have you ever suffered from or been diagnosed with any of the following?:

• Inflammatory bowel disease including Chrons Disease and Colitis
• Any other disorders of the stomach (e.g Ulcers or Gastritis)
• Cardiovascular problems including stroke or heart attack
• Fast heart rate (Tachycardia)
• Liver or kidney problems 
• Polycystic Ovary Syndrome (PCOS)
• Diabetic retinopathy/Diabetic eye disease
• Pancreatitis
• Gallstones
• Cholestasis
• Chronic malabsorption syndrome
• Mental health problems (including anxiety, depression, bipolar or have suicidal thoughts)
• Eating disorder (e.g anorexia or bulimia)

Have you ever had a reaction to Saxenda, Wegovy, Liraglutide, Semaglutide Or have any other allergies we should be aware of?

Are you currently taking or have recently finished taking (in the last month) any OTHER medication, whether prescribed or non-prescribed including over-the-counter, herbal, or recreational drugs?

Do you have or suffer from any of the following listed below?

• Dysglycaemia (Abnormal sugar levels)
• Hypertension (High blood pressure)
• Dyslipidaemia (High Cholesterol)
• Obstructive sleep apnoea
• Asthma/Chronic obstructive pulmonary disease (COPD)
• Thyroid cancer or a family history of thyroid cancer
• Erectile Dysfunction

Please confirm you understand how to dispose of the medication safely in addition to safe disposal of needles?

All used needles should be placed in the sharps bin (which is provided free of charge on request when ordering medication from us) and disposed of safely. This can be disposed of at a local Pharmacy offering a needle exchange service, at your GP practice, or by contacting your local council.

Please enter your weight (and state the Units e.g Kg or Stone/Ib)

Please enter your height (and state the Units e.g Centimetre/Feet and Inch)

Please confirm the following:

• I confirm the above questions have been answered truthfully and accurately. I understand that any incorrect information may be detrimental to my health
• I confirm the medication is for my personal use only and I will take the medication as prescribed or directed for its intended use
• I have read the patient information leaflet and I will contact a medical professional if I have any questions or experience any side effects while taking the medication
• I understand there have been rare cases of patients developing inflammation of the pancreas whilst taking Saxenda/Wegovy. I will stop taking the medication immediately if I experience any of the following serious side effects: Abdominal pain that radiates to my back, Abdominal pain that feels worse after eating, Fast heartbeat, Vomiting, Yellowing of the skin and eyes (Jaundice), Fever
• All information provided will be handled in the strictest confidence in line with GDPR regulations. I am happy for e Shop Pharmacy to collect and use the information I provide for the purposes of providing treatment for my medical condition
• I am happy to be treated by the prescribers and health care professionals at e Shop Pharmacy and the final decision on whether to provide treatment will be with the prescriber and or pharmacist
• I understand how to administer injected weight loss medication subcutaneously. Details on how to administer the medication can be found at the following link: https://youtu.be/B1kldLAX2uk
• This medication is subject to additional monitoring requirements by the Medicines and Healthcare Products Regulatory Agency (MHRA)and so any side effects must be reported to them via the Yellow Card Scheme.
• It is important to maintain a good level of hydration to avoid suffering from dehydration.
• I understand I must have my blood pressure checked regularly whilst taking this medication
• I understand that my order will be reviewed by a Prescriber and I must book either a video call or a free home visit to verify my BMI before my order can be approved
• Weight Loss Injections must be used in conjunction with ongoing lifestyle changes of a reduced calorie diet and increased physical exercise
• I have read and accept the terms & conditions and privacy policy

New Regulations For Prescribing Weight Loss Injections 

We will need to independently verify your BMI. This will mean you will need to either:

• Book a free 15-minute video call with one of our Pharmacists
• Attend our clinic in Macclesfield or London to verify your weight
• Or Book for one of our Nurses to visit you at home

Please make sure your BMI is 30 or above. If you book for a Nurse to visit you at home and your BMI is less than 30, we will refund you any monies paid minus £65 for a home visit charge