Customer Service

Prescription Requests

NameJohn Mulcahy
What is your current height (enter as centimeters)?161
What is your current weight (enter as kg)?45
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?No
Do you Smoke?No – I have never smoked
Have you tried any other weight loss programmes in the past such as dieting or exercise?Yes
Are you currently taking any weight loss medication?No
Have you taken any weight loss medication in the past?No
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 PillNo
CiclosporinNo
Warfarin or DOAC (also known as a Direct Oral Anticoagulant or NOAC) such as Apixaban, Rivaroxaban, Edoxaban or DabigatranNo
Epilepsy MedicationNo
Thyroid MedicationNo
AmiodaroneNo
Are you taking any prescription-only medicines, over-the-counter medicines, alternative medicines or recreational drugs?No
Are you allergic to any of the following? Please select all that apply.
  • Nuts
Nuts
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
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
Phone Number0896026555
Your Emailjackmulcahy@hotmail.com

Prescription Renewal Requests