Customer Service
Prescription Requests
Name | John Mulcahy |
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What is your current height (enter as centimeters)? | 181 |
What is your current weight (enter as kg)? | 100 |
What sex were you born as? * | Male |
Do you do 3 or more hours of some form of moderate exercise a week? | Yes |
Do you do regularly drink alcohol? | Yes |
Do you Smoke? | No – I have never smoked |
Have you tried any other weight loss programmes in the past such as dieting or exercise? | No |
Are you currently taking any weight loss medication? | No |
Have you taken any weight loss medication in the past? | Yes |
Which weight loss medication have you taken in the past?? | VINox |
How much weight did you lose? | 5 Kgs / 11lbs – 10 Kgs / 22lbs |
Did you experience any side effects from the weight loss mediciation in the past? | Yes |
Please give more details of your side effects in the past: | Nose bleeding |
Have you been diagnosed with high blood sugar levels or diabetes? | No |
Do you currently suffer from either heart disease, high blood pressure or are you being prescribed a treatment for high blood pressure? | No |
Have you ever suffered from obstructive sleep apnoea? | No |
Are your daily activities currently affected by your weight? | No |
Even after being rested, do you still feel tired and lacking energy? | NO, I'M NOT |
The Contraceptive Pill | No |
Ciclosporin | No |
Warfarin or DOAC (also known as a Direct Oral Anticoagulant or NOAC) such as Apixaban, Rivaroxaban, Edoxaban or Dabigatran | Yes |
Epilepsy Medication | No |
Thyroid Medication | No |
Amiodarone | No |
Are you taking any prescription-only medicines, over-the-counter medicines, alternative medicines or recreational drugs? | No |
Do you have any other known allergies? | No |
We need to check if you are at risk of heart disease. Please tick all that apply: |
|
None of the above | |
Have you ever been diagnosed with a problem of absorbing your food, sometimes called chronic malabsorption syndrome? | No |
Do you have a history of kidney or liver disease? | No |
Have you ever been diagnosed with gallbladder, bile duct or pancreas disease? | No |
Have you ever had any form of gastric surgery, such as removal of any part of your GI tract? | No |
Do you have or have you ever been diagnosed with an eating disorder such as anorexia or bulimia? | No |
Are you pregnant or planning to become pregnant within the next six months? | No |
Are you breastfeeding? | No |
Have you noticed it difficult when it comes to thinking, remembering or making decisions? | NO, I DO NOT |
Do you feel sad or anxious for 2 weeks or more on a continuous basis? | No |
Your Email | jackmulcahy@hotmail.com |