- Prescription Feedback

Overview

 

Before you request a prescription (or a prescription renewal) for your weight-loss medication, we suggest you complete the feedback form below to give your prescribing doctor some information on how you have felt while taking the weight-loss medication – including the amount of weight you have lost – and any side effects you have encountered.

 

It is VERY important that you provide this information carefully and completely.

 

Your Doctor can only view this information AFTER you have LINKED PROFILES.

My Feedback Form to My Doctor

- Your Previously Submitted Feedback Forms

My Previous Submitted Feedback Forms Click on the date to read the full feedback form
Date CreatedHow many months have you been on your weight-management medication?How much weight have you lost?Do you wish to continue with the medication you are currently prescribed?

No entries match your request.
Date CreatedHow many months have you been on your weight-management medication?How much weight have you lost?Do you wish to continue with the medication you are currently prescribed?