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Repeat Treatment Form

Online Review Form

Please fill out the following form
to order your repeat product. Please note, if you are making payment for your order under a different name / email address, please let us know via the notes below or via email. Please ensure your delivery address at checkout or on the invoice is the correct shipping address - this will be the address used to deliver your product to. If there are any inaccuracies, please let us know as soon as possible via email.

Your Details

Please select what unit of measurement your weight is:
Has there been any changes to your medical history since your last order?
Your package is sent via special delivery for £4.99 & needs to be signed for. What days can you accept deliver?

For your information:

Please read the below information. ​Only click agree if you fully understand the information. If you are unsure, please contact us via email.

Licensing of the medication:

Saxenda (liraglutide), Wegovy (semaglutide) and Mounjaro (tirzepatide) are licensed for weight loss the UK & EU.

Ozempic (semaglutide), Rybelsus (semaglutide) and Trulicity (dulaglutide) are NOT yet licensed for weight loss in the UK & EU. They are currently licensed for Type 2 diabetes.

A medication can be prescribed for a purpose other than it's current license - this is called off-label prescribing. You must be aware and fully informed of this, plus all the information regarding the medication (how it works, side effects etc) before being prescribed a medication off-label.

Side Effects:

Everyone is different. You may not experience any side effects, you may experience one side effect or several side effects.

 

The most common side effects associated with this medication are:

​​

  • Nausea

  • Headaches

  • Dry Mouth

  • Constipation

  • Loose Stool

  • Tiredness

  • Stomach Cramps

Further information is available via our FAQ page and the aftercare page in the My Account section of the website. Please do not hesitate to contact us if you need any support on dealing with side effects. We are more than happy to advise you.

Adverse Effects:

Adverse effects are rare but they are something you should be aware of.

Adverse effects may include:

  • Palpitations / Fast Heart Rate

  • Pancreatitis

If you experience or feel that you may be experiencing these adverse effects, please stop using the medication & contact 111. When you are safe to do so, please contact us.

Anaphylaxis:

There have been no documented cases of an anaphylactic reaction to these medications but as this is a new medication being introduced to your body, we want to make you aware of the possible signs of anaphylaxis.

If you experience swelling of the lips/tongue/throat, difficulty breathing, tightness in the chest, a severe rash or severe itching, discontinue use immediately and call 999.

Cancellation, Delivery, Returns & Refunds:

Please read our policies on cancelling an order, delivery, returns and refunds. Any orders placed and screened but not yet dispensed/shipped can be cancelled by written communication - there will be a £10 admin fee to cover expenses in reviewing your form.

What are the next steps?

REVIEW
We send your form to the pharmacy for review.

DELIVERY
The pharmacy will deliver to your chosen address.

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