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Medical Assessment for Weight Loss Treatment

Complete this short online consultation so our medical team can show you suitable treatments.

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Tell us about yourself
Are you aged 18 or over? (You must be at least 18 years old to complete this medical consultation and receive treatment)
Your Health Information
Have you ever had an allergic reaction to orlistat?
Are you currently pregnant, breastfeeding, or planning to become pregnant or start breastfeeding while taking this medication?
Do you have any existing medical conditions or past health problems from the list below? (This information helps ensure your treatment is safe and suitable for you.)

Cholestasis â€“ a condition where the flow of bile from the liver is reduced or blocked, which can affect digestion and medication safety.

Chronic malabsorption syndrome â€“ diagnosed by a GP; a long-term condition where the body cannot properly absorb nutrients from food.

Gallbladder removal (cholecystectomy) â€“ previous surgery to remove the gallbladder, which may affect digestion and fat absorption.

Kidney problems â€“ including reduced kidney function or chronic kidney disease.

Liver problems â€“ such as liver inflammation, fatty liver, cirrhosis, or any diagnosed liver disease.

Serious medical condition requiring urgent hospital care â€“ any condition that may cause sudden deterioration and require immediate medical attention.

Thyroid problems â€“ including an underactive or overactive thyroid (hypothyroidism or hyperthyroidism) or any diagnosed thyroid disorder.

Do you have any past history of an eating disorder, including anorexia nervosa or bulimia?
Your Current Medication
Are you taking any medicines right now such as prescription medicine, shop-bought treatments, herbal supplements, or recreational drugs?
Do you use any medication for cholesterol, diabetes, or blood pressure control?
Do you take an oral contraceptive pill at the moment?
Patient Declaration & Agreements
Do you agree to the following? Please read each statement carefully before confirming. This ensures you understand how your treatment will be supplied and used safely.

☑️ I will read the Patient Information Leaflet provided with my medication before use.

☑️ I will contact ifeelshy and inform my GP immediately if I experience any side effects, start a new medication, or if my medical conditions change during treatment.

☑️ I understand that the treatment is for my personal use only and will not be shared with anyone else.

☑️ I confirm that I have answered all questions accurately and truthfully to the best of my knowledge.

☑️ I understand that the prescriber relies on my answers in good faith, and that providing incorrect or incomplete information could affect my health.

☑️ I understand that while treatment decisions are made jointly between myself and the prescriber, the final decision to issue a prescription rests with the prescriber.

Can you confirm that the treatment must stop if your BMI falls below 28, as it is only recommended for people with a BMI of 28 or above?
Can you confirm that treatment must stop if your weight increases during the first 3 months, because a lack of early weight loss shows the treatment is not suitable for you?
Can you confirm that you understand a daily multivitamin (with vitamins A, D, E and K ) is required because Orlistat reduces the absorption of these vitamins, and that it should be taken at least 2 hours separately from Orlistat, such as at bedtime?