Please provide your medical history prior to meeting with our consultant.

Medical History

We’ll ask a few questions about your weight and health to assist our consultant in recommending a safe and effective treatment plan for you.

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Medical History

Have you been diagnosed with any of the following conditions?

Diabetes

High blood pressure

High cholesterol

Heart or blood vessel disease (including previous heart attack)

Previous stroke

Obstructive sleep apnoea

Acid reflux or GORD (and taking regular medication)

MASLD (previously NAFLD)

Osteoarthritis

Depression (and taking regular medication)

Erectile dysfunction

PCOS

None of the above

Thank you for being honest with Pharmazon.

Could you please provide more details about the medication you're taking, including the dosage and how long you’ve been using it?

Medical History

Do you have, or have you ever had, any of the following?

Pancreatitis

Eating disorder

Weight loss surgery in last 12 months

Medullary thyroid cancer or MEN2

Cancer currently under treatment

Active retinopathy

Heart failure with SOB at rest

None of the above

Thank you for being honest with Pharmazon.

Could you please provide more details about the medication you're taking, including the dosage and how long you’ve been using it?

Medical History

What type of diabetes of you have?

Prediabetes

Type 1 diabetes

Type 2 diabetes

None of above

Thank you for being honest with Pharmazon.

Could you please provide more details about the medication you're taking, including the dosage and how long you’ve been using it?

Medical History

Do you have any gallbladder issues?

Gallstones

Blocked bile flow

Cholecystitis

Gallbladder surgery in last 12 months

None of the above

Thank you for being honest with Pharmazon.

Could you please provide more details about the medication you're taking, including the dosage and how long you’ve been using it?

Medical History

Do you have, or have you ever had, any of these conditions?

CKD (eGFR <30)

Severe GI disease

Malabsorption

Liver cirrhosis or transplant

Endocrine disorder

Alcohol rehabilitation

Cognitive impairment

None of the above

Thank you for being honest with Pharmazon.

Could you please provide more details about the medication you're taking, including the dosage and how long you’ve been using it?

Medical History

Are you currently taking any of the following medications?

Amiodarone

Carbamazepine

Ciclosporin

Clozapine

Digoxin

Fenfluramine

Lithium

Mycophenolate mofetil

Oral methotrexate

Phenobarbital

Phenytoin

Somatrogon

Tacrolimus

Theophylline

Warfarin

None of the above

Thank you for being honest with Pharmazon.

Could you please provide more details about the medication you're taking, including the dosage and how long you’ve been using it?

Medical History

Do you have previously received weight management treatment?

Yes

No

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Note: Ensure your prescription label, clinic letter, or pharmacy record confirms your dosage and usage instructions.

Doctor

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