1. About Your Health

Please provide your Height and Weight so we can calculate your BMI

Your BMI must be over 30 to qualify, or between 27-30 with at least one weight related comorbidity such as pre-diabetes, diabetes, hypertension, dyslipideamia or obstructive sleep apnoea.

By clicking Continue you agree to our Privacy Policy and confirm you are over 18.

What is your ethnicity?

Why do we ask this? Optimal Body Mass Index (BMI) ranges may vary based on an individual's ethnic background.

Please select below

Is your blood pressure Low, Normal or High?

Use the following as a guide: Low = Under 90/60, Normal = Between 90/60 and 140/90, High = Over 140/90

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Do you suffer from any allergies?

If you do, kindly explain them below.

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Do you currently take any medication or have you recently finished a course of medication?

Please list all your current prescription medication, including any medication you buy over the counter.

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Do you have, or have you ever had, any of the following medical conditions?

Please tick all that apply

Do you have a medical condition or take medication that may contribute to your weight gain?

Examples include growth hormone deficiency, polycystic ovary syndrome, Cushing's syndrome, hypothyroidism, hypothalamic damage (e.g. tumour, trauma, or surgery)

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Have you had surgery (an operation) in the last 6 months?

And do you have any planned in the near future?

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2. About your Weight Loss

Have you previously been on a course of any prescription treatments, such as:

• Ozempic
• Wegovy
• Mounjaro
• Orlistat
• Xenical
• Saxenda

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Are you currently on a course of any prescription weight loss treatments from another supplier?

If you’re currently using a prescription weight loss treatment from another supplier, please upload an image of the medication box showing the label.If you are not, then you can skip this question and press Continue

Upload Image (optional)

Only images are accepted (JPG, PNG, GIF, WEBP).

Women only: Are you pregnant or breastfeeding?

Is there any chance of you being pregnant? If you are male, simply answer "No".

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Have you tried to manage your weight by altering your diet and increasing physical activity?

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Can you think of any other health or medical detail not mentioned so far?

Please let us know anything else that may be relevant to your treatment.

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3. The Agreement and Consent

To ensure you understand key information about your treatment, read the below statements carefully and acknowledge understanding.

• I understand I should use one weight loss product at any one time
• I understand that the best and safest weight loss outcomes are achieved by slowly and carefully titrating the dose as per the dose escalation schedule to gain the maximum benefit from the medication. I understand that if I have a gap in treatment longer than 2 weeks, I may need to reduce my dose to avoid side effects.
• I understand that Wegovy/Mounjaro is used as an injection under the skin (subcutaneous injection). I will not inject it into a vein or muscle. The best places to give the injection are the upper arms, stomach or upper legs. I will ensure to drink plenty of fluids to avoid dehydration. I can find detailed instructions on using Wegovy/Mounjaro in the Patient Information Leaflet in the box.
• I understand that I will stop treatment and inform Medicine Drop Pharmacy and/or seek medical attention if I experience severe dehydration, e.g. dark urine, confusion, blood in stool or vomit, diarrhoea lasting longer than 72 hours, or being unable to keep food down without vomiting/diarrhoea.
• I understand that It is important for female patients to use reliable contraception throughout treatment with Wegovy and Mounjaro. You must stop Wegovy at least 8 weeks before trying to conceive and Mounjaro at least 4 weeks before trying to conceive. If you use oral hormonal contraception (such as the pill) while on Mounjaro, you will need to use additional barrier methods of contraception (such as condoms) for 4 weeks when starting treatment and each time you increase to a new dose. If you become pregnant while using either treatment, discontinue use immediately and consult your GP. Please tick to confirm you have read and understood this information.
• I understand that if I experience any troublesome side effects from Wegovy/Mounjaro, I can contact Simple Online Pharmacy, my GP, or another healthcare professional for advice. I confirm that I will read about the side effects in the Patient Information Leaflet.
• I confirm that I understand that if I place an order for Wegovy/Mounjaro after 12pm on a Saturday, Simple Online Pharmacy will not ship my order until Monday (unless a public holiday) due to the medication being a temperature/time critical item. This applies even if you choose the 'next day delivery' option on the checkout page.
• I confirm this treatment is for me, and I consent to this treatment. If Wegovy/Mounjaro does not help me realise my weight loss aims, I will consult my GP for further advice. I take responsibility to inform Simple Online Pharmacy and/or my own regular doctor of any changes in my circumstances. I agree to the Simple Online Pharmacy terms and conditions.
• I confirm that all the above information is truthful and accurate. I agree to inform SOP of any change to my health as soon as possible, as I understand this could impact the suitability of the medication I am being prescribed.

By continuing to proceed you agree to our Terms & Conditions.

Do you agree to the above?

Video Call & Final Confirmation

Before we can approve your first order, a short video call with our pharmacy team is required. You can book this call from your dashboard following checkout, and we’ll also email you a reminder.

Please note: existing patients who are migrating from our previous system may not need to book a video call. We will assess this when the order is processed.

Please confirm you understand that:

• Your consultation will only be reviewed once all questions are completed and checkout is finished.
• A video call must be booked for your initial order.
• If you don't qualify you'll receive a full refund.

Do you agree to the above?