Weight Loss Consultation Form

Complete this consultation form to check your eligibility for our weight management programme. 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.