Weight loss consultation form

    Your journey begins here—let us guide the way!

    To provide the best care, we’ll ask you a few questions to assess your eligibility and customise your treatment plan to suit your needs.

    Rest assured, all your responses will be handled with the utmost privacy and confidentiality, ensuring a safe and personalised experience.

    Customer Journey Outline

    Once you’ve completed this form, our expert team will carefully review your responses and assess whether you’re a suitable candidate for the weight loss injections we offer. Based on the information you provide, we will design a personalised treatment plan specifically tailored to support your health and help you achieve your weight loss goals.

    Here’s what happens next:

    1

    Initial evaluation and eligibility check

    Our team will assess the information you’ve provided to ensure that you’re eligible for the weight loss injections. This process involves evaluating your current health status and previous medical history to ensure the offered treatment aligns with your specific needs.

    2

    Personalised treatment plan

    If you meet the eligibility criteria, our team will create a customised plan. This will include appropriate medication and dosage recommendations based on your needs to ensure the treatment is safe and effective and helps you achieve your desired outcome.

    3

    Ongoing support

    We’ll be with you every step of the way and our team will regularly monitor your progress. If you have any questions or need changes to your plan, we're just a message or call away. Our team is committed to helping you stay motivated, informed, and on track throughout your journey.

    Section 1: Personal details













    Section 2: Medical history
















    Section 3: BMI verification

    To ensure safe and appropriate treatment, we need to verify your BMI.



    Please upload a full-length photo of yourself that meets these requirements:

    • Full-length view (head to feet)

    • Clear and well-lit photo

    • Should not be blurry

    • Your photo only

    • Wear form-fitted clothing

    • Avoid loose or baggy clothes

    • Hold a piece of paper with today’s date handwritten


    Section 4: Consent

    Scroll to Top