Have you used any weight loss treatments previously?
Are you pregnant or breastfeeding?
Please do not proceed, this condition will disqualify you from receiving a prescription. Are you using any contraception?
It is advisable to be on contraception while using Ozempic as it is contraindicated in pregnancy and breastfeeding.
Ozempic can cause birth defects and should be stopped at least 2 months before a planned pregnancy Do you have any of the following symptoms?
Please do not proceed, this condition will disqualify you from receiving a prescription. Do you have a history of any of the following?
Please do not proceed, this condition will disqualify you from receiving a prescription. Is your hypertension well controlled?
Please do not proceed, this condition will disqualify you from receiving a prescription. Are your blood-sugar levels well controlled?
Please do not proceed, this condition will disqualify you from receiving a prescription. Are you using Insulin or other injectable diabetic medication?
Please do not proceed, this condition will disqualify you from receiving a prescription. Do you or any family members have a history of thyroid problems?
Please do not proceed, this condition will disqualify you from receiving a prescription. Do you have any neck growths or masses?
Please do not proceed, this condition will disqualify you from receiving a prescription. Have you ever been diagnosed with Multiple Endocrine Neoplasia?
Please do not proceed, this condition will disqualify you from receiving a prescription. Do you have a history of an eating disorder e.g. anorexia or bulimia?
Would you like to be referred to our telemedicine psychologist for regular mental health sessions?
Do you have any other medical conditions?
Are you currently taking any medication?
Do you have any allergies including allergies to medication?
Did you have a blood-pressure reading in the last 3 months?
Please do not proceed – please return to this service once you have checked your blood pressure e.g. self check/local pharmacy/clinic Is your resting heart rate between 60-100 beats per minute?
Please do not proceed, this condition will disqualify you from receiving a prescription. Did you have a blood-glucose reading in the last 3 months?
Please do not proceed, this condition will disqualify you from receiving a prescription. Range must be between 4-10
Please do not proceed – please return to this service once you have checked your blood-glucose level e.g. self check/local pharmacy/clinic Have you done blood tests in the last 12 months including kidney function, liver function, thyroid function, cholesterol
Weight loss medication will only be effective when part of a proper diet and exercise plan. If you are not seeing a dietitian, would you like to be referred to our partner telemedicine dietitians?
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