| Date Created | Name | How many months have you been on your weight-management medication? | How much weight have you lost? | Have you started taking any other prescribed medication since your last prescription for weight loss medication? | If yes, you have "started taking other prescribed medication", please describe it here. | Please describe in general how you feel your weight loss program is going | Please describe in detail any (and all) the side effects you may have felt. | Do you wish to continue with the medication you are currently prescribed? | If yes, do feel comfortable maintaing the scheduled dosage in line with the pharmaceutical manufacturer | If no, please indicate what you feel like doing at this time. |
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| Date Created | Name | How many months have you been on your weight-management medication? | How much weight have you lost? | Have you started taking any other prescribed medication since your last prescription for weight loss medication? | If yes, you have "started taking other prescribed medication", please describe it here. | Please describe in general how you feel your weight loss program is going | Please describe in detail any (and all) the side effects you may have felt. | Do you wish to continue with the medication you are currently prescribed? | If yes, do feel comfortable maintaing the scheduled dosage in line with the pharmaceutical manufacturer | If no, please indicate what you feel like doing at this time. |
