Liraglutide (Saxenda | Victoza) New User – Weight Management

Name

Surname

Phone Number

ID Number

Have you used our services before?

Address

City

Postal Code

What is your current weight in Kilograms (kg)?

What is your current height in Centimeters (cm)?

Have you used any weight loss treatments previously?

When did you first notice your increased weight?

Are you pregnant or breastfeeding?

Are you using any contraception?

Do you have Type 2 Diabetes?

Are you using Insulin or other injectable diabetic medication?

Do you or any family members have a history of thyroid problems?

Do you have any neck growths or masses?

Have you ever been diagnosed with Multiple Endocrine Neoplasia?

Do you have a history of an eating disorder e.g. anorexia or bulimia?

Do you have any other medical conditions?

Are you currently taking any other medication?

Do you have any allergies including allergies to medication?

Have you had any medical workup done for your weight issue?

Weight loss medication will only be effective when part of a proper diet and exercise plan. If you are not seeing a dietitian, would you like to be referred to our partner telemedicine dietitians?

Please upload a recent full body photo of yourself (with clothes and without showing your face), for our doctors to properly assess you.

I have read and agree to the Terms and Conditions and Privacy Policy (POPI) of the use of this Website and Service. I understand the questions above and have answered honestly. I understand that any inaccurate or false information could potentially be dangerous to my health and safety. The medication that is prescribed is for my personal use only. I understand the side effects and effectiveness of the treatments.I agree to the Terms & Conditions of this platform.I am 18 years or older.I am currently living in Zimbabwe

I Agree to the terms and conditions of this Prescription Application and that of the use of this service.

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US$ 10,00