Pictures Only

Complete this picture upload form to confirm eligibility for weight loss products. This form will be reviewed by a UK-registered prescriber before any treatment is approved. You may be required to provide additional verification, such as a video consultation or GP notification. Please ensure all information is accurate, as this will affect your treatment eligibility. Your data is encrypted and handled in accordance with GPhC and GDPR regulations. If you have any questions, contact our pharmacy team before proceeding 0208 191 3034.

Name(Required)
DD slash MM slash YYYY
Max. file size: 256 MB.
A fully clothed picture is acceptable as long as the picture is a full length front profile picture.
Max. file size: 256 MB.
A fully clothed picture is acceptable as long as the picture is a full length side profile picture.
Max. file size: 256 MB.

Weight Loss Treatments

4 Week Dose, Special Next Day Delivery, Pharmacy and Prescriber Support. 

*Please complete consultation form before purchase. 

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