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Weight LossForever

Prescription request

Request a prescription

For people already on treatment who need a continuing supply, or who are moving from another provider. A prescriber reviews every request — a repeat is still a clinical decision, not an automatic reorder.

This is not an order and not a prescription. Nothing is dispensed, and no payment is taken, until a named prescriber has reviewed your answers and decided that treatment is appropriate for you.

About you
Height and weight
Is your family background South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean?

NICE advises lower BMI thresholds for these backgrounds, because metabolic risk appears at a lower BMI. It can make you eligible where a single cut-off would not.

Your medical history
Do you have a weight-related health condition, such as type 2 diabetes, high blood pressure or sleep apnoea?
Are you pregnant, breastfeeding, or planning to become pregnant?
Have you or a close family member had medullary thyroid cancer or MEN2?
Have you ever had pancreatitis?
Have you ever been diagnosed with an eating disorder?
Have you had gallbladder disease or gallstones?
Do you have type 2 diabetes?
Consent

Health data is a special category under UK GDPR and is processed on the basis of the explicit consent you give above. You can withdraw it at any time, though clinical retention rules can limit erasure of a record a prescriber has acted on. Our privacy policy explains this in full. Read the privacy policy

This form is not a route for urgent medical problems. If you are acutely unwell, contact your local emergency service.

New here?

If you have not been assessed by us before, start with the clinical assessment instead. It asks the same questions plus the ones a first prescription needs.

Start a new assessment

This form is not a route for urgent medical problems. If you are acutely unwell, contact your local emergency service.