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Weight Loss Consultation Questionnaire

If you are a new patient, please complete the following questions to help us better understand and treat your condition. It’s very similar to visiting a GP but without leaving home. Our Doctors will then review your responses and confirm approval of your treatment. If we can’t prescribe you a treatment, no payment is taken and we’ll do our best to suggest alternative options.


(e.g. high or low blood pressure, previous heart attacks, angina, irregular heart rhythm)


(e.g. asthma, COPD, bronchiectasis)


(e.g. hepatitis, fatty liver, alcohol liver disease)

(e.g. diabetes, thyroid problems)

(e.g. anxiety, depression, personality disorder)

(e.g. parkinsons, previous stroke or mini-stroke)











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