Start your weight loss journey

By clicking ‘Continue,’ you confirm that you are over 18, reside in the UK, and will be the sole user of any medication provided through this service. You also acknowledge that all information you have provided is truthful and accurate.

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What ethnicity are you?

Asian or Asian British

Black, Black British, Caribbean, or African

White

Mixed

Arab

Other

Prefer not to say

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What sex were you assigned at birth?

Male

Female

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Are you currently pregnant, trying to get pregnant, or breastfeeding?

Yes

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What is your date of birth?

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What is your height & weight?

Height

Weight

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What is your height & weight?

Feet

Inches

Stone

Pounds

lbs

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Have you been diagnosed with diabetes?

It's important to keep us informed if your doctor starts you on any medication relating to your pre-diabetes/diet controlled diabetes

I have diabetes type 1 and take medication for it

I have diabetes type 2 and take medication for it

I don't have diabetes

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Do you suffer from any of the following?

Liver, kidney or heart failure

Pancreatitis

Multiple endocrine neoplasia type 2

Cancer

Type 1 diabetic retinopathy

Personal or family history of medullary thyroid cancer

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History of an eating disorder (e.g anorexia, bulimia)

History of gallbladder problems

History of inflammatory bowel disease or gastroparesis

None of these statements apply to me

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Please list any other medical conditions you have. Our clinicians need to know your full medical history to make sure treatment is safe for you to take.

I don’t have any medical conditions

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Please select any of the following medical conditions if they apply to you

I have been diagnosed with a mental health condition such as depression or anxiety

I have or have an eating disorder such as bulimia, anorexia nervosa, or a binge eating disorder

None of these statements apply to me

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Please tell us more about your specific diagnosis and how you manage it

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Have you ever used any other medications to aid in weight loss?

Yes

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Are you presently taking this medication?

Yes

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Can you tell us how long you have been taking this medication and share your experience with it?

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How did you respond to the medication, and what led you to discontinue its use?

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Please indicate whether you are presently using any medication, such as prescription drugs, over-the-counter medications, or supplements, by selecting all that are applicable to you.

I'm on Levothyroxine or Warfarin

Other

I don't take any medication

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Please tell us more about tge medication you’re using

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Have you ever been diagnosed with an eating disorder by a healthcare professional?

Yes

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Have you taken Ozempic, Rybelsus, Wegovy or Saxenda medication in the past 28 days?

Yes

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Have you taken Ozempic, Rybelsus, Wegovy or Saxenda medication in the past 28 days?

Yes

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As you have taken Mounjaro, Ozempic, Rybelsus or Saxenda medication in the past 28 days, please provide a photo of your medication.

Ensure that your name and prescription is visible

Upload Photo

I’ll do this later

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Do you have any known allergies? If yes, please list them clearly in the space provided below.

I don’t have any allergies

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Can you confirm if you would like your NHS GP to be made aware if you are deemed eligible for treatment?

Yes

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Input GP Details

Surgery Name

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You’r eligible for Dr Frank’s Weight Loss Programme!

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