WeightLossClinic – Dickson Chemist

Start your weight loss journey today!

Step 1: Fill in your details

Step 2: Choose a time for your consultation

Step 3: Start losing weight!

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- Step 1 of 8

Lose weight with Mounjaro

Benefits of using our online weight loss service:

One of the most cost effective services on the internet - save hundreds of pounds a year compared to other providers.
Speak to a real prescriber expert on the phone - who can talk you through the whole process.
Weight loss injections come with needles and sharps bins
Lose up to 22.5% of your starting weight
Once you’ve been issued a prescription, treatment is delivered discreetly to an address of your choice
Quick and easy repeat prescriptions posted discretely to your home
COST: Consultation for £50 to join our clinic, skinny pens start at £128.50 for 4 weeks

Ready to start your weight loss journey? Click NEXT below.

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Lets find out all about you!

Please fill in the form below giving as much detail as you can. If you need to stop you can save the form and come back to it later by pressing the button at the bottom of the page..

Name *

Your full name as it appears on your ID

Address *

Address Line 1

City

State / Province / Region

Postal Code

Date of birth *

Phone Number (MOBILE BEST) *

Email *

(A copy of this consultation is emailed to you)

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Mounjaro Suitability

In order for most people to be suitable for Mounjaro you must have a BMI >27. If you are transferring to us from another clinic for maintenance - let us know by ticking the box below. Please fill in your current weight and height below.

Unit of measurement *

Height (cm) *

Weight (kg) *

Height *

Feet

Inch *

Inches

Weight (lbs) *

BMI

Verdict

If you are transferring to us from another clinic please tick this box

My BMI is below 27 but I am currently on therapy and need maintenance treatment only

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for helps

Now for the evidence!

In order to comply with UK legislation, we need evidence of your weight. Please take a picture of you standing on a weighing scale - where we can clearly see the numbers on the scale. If you don't have a scale, then a picture of a printout from a commercial weighing machine, or weight taken at a doctors visit will do!

A picture of you standing on a scale or equivalent *

Click or drag a file to this area to upload.

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Get your smile on 🙂

We need a full length picture of you - standing straight upright. In a mirror - or get your friend to do it for you. (Don't worry only our clinicians and you can see this..... this is the before, in not too long we will be taking an after!)

Say Cheese! Upload a full length picture of you! *

Click or drag a file to this area to upload.

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Finally we need photographic ID

The law in the UK requires us to verify that you are who you say you are by providing us with photographic ID. Drivers License, Passport, or a picture of you holding a utility bill is sufficient!

Your photographic ID *

Click or drag a file to this area to upload.

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Now a little about you

This is where we need a few bits of information to make sure Mounjaro (or similar therapies) are safe for you. Please be honest and tell us everything you can.

Medical Conditions I have

High Blood Pressure
High Cholesterol
Sleep Apnoea
Cardiovascular Disease
Pre-diabetes
Type 2 Diabetes
Thyroid Cancer

Medical Conditions primary family members have (genetic relation)

High Blood Pressure
High Cholesterol
Sleep Apnoea
Cardiovascular Disease
Pre-diabetes
Type 2 Diabetes
Thyroid Cancer

Please list all medicines you take regularly - if none leave this part blank

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Informed Consent

To comply with UK legistlation we need you to agree to the following statements - just tick the boxes! (Nearly done though!)

Mounjaro helps you lose weight by reducing your appetite and making you feel fuller for longer which decreases how much food you eat. Mounjaro works like two natural hormones in our bodies that help control appetite, blood sugar levels, and digestion, they are called GLP-1 and GIP. When Mounjaro binds to GIP and the GLP-1 receptors you feel less hungry, it slows the rate food passes through your body, causes the pancreas to release more insulin and lowers the amount of sugar your liver makes, which helps you loss weight and help controls blood sugar levels. I understand that it needs some willpower! *

Got it!

Mounjaro and similar drugs have a theoretical risk of increasing the incidence of Thyroid Cancer- the European Medicines Agency recently stated that there was no evidence supporting the effect in humans, as the development of thyroid cancer was only seen in rats. This means the drug is unlikely to cause thyroid tumours in humans, however, if you have a strong family history of thyroid cancer - this may not be the weight loss therapy for you. *

I understand - no-one in my direct family has thyroid cancer (including myself)

A serious rare and potentially life threatening side effect is acute pancreatitis. This is thankfully a very uncommon issue with these medicines, however, prompt action if you develop the symptoms is important.

Please watch this video by clicking here

I have watched the video and know the symptoms of acute pancreatitis. If I develop these symptoms (however unlikely that is) I will go to the hospital immediately. *

Got it!

The average Mounjaro weight loss was 16.1 kg (35.5 lb) after 72 weeks on a 5mg weekly dose, 22.2 kg (48.9 lb) on Mounjaro 10mg weekly dose, 23.6 kg (52.0 lb) on 15mg weekly dose, compared to patients who used a placebo lost 2.4 kg (5.3 lb) over the 72 weeks. These results are from the 72-week clinical trial (SURMOUNT-1, NCT04184622) using tirzepatide for weight loss in adults with obesity. Individual results may vary a lot depending on your own commitment to additional exercise and diet restriction. *

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Side effects - what to expect

Self-Limiting Side Effects that will usually resolve without intervention

Bloating
Diarrhea
Mild stomach discomfort
Heartburn
Nausea (Occasionally vomiting)

Serious side effects that require immediate attention

Acute pancreatitis
Stomach pain that doesn't go away

I have read the side effects and understand *

Got it!

Pregnancy: If it is possible for you to get pregnant, you must take precautions against it during treatment as Mounjaro can harm the unborn baby. *

Got it!
Not applicable

After paying £50 to join our clinic, our patients qualify for these very low rates on Mounjaro.

Mounjaro 2.5mg Injection	£128.8
Mounjaro 5mg Injection	£128.8
Mounjaro 10mg injection	£142.5
Mounjaro 12.5mg Injection	£158
Mounjaro 15mg Injection	£158

I understand that by joining the clinic I will have to first speak to an expert prescriber, then to a clinician at least once a month initially then every 3-6 months. Getting supply on an ongoing basis is dependent on having these conversations truthfully and honestly. *

Got it!

I formally consent for my data to be used for the purposes of Dickson Chemist providing a consultation for medically assisted weight loss. I have been truthful and honest in my questions and will let them know if anything changes. *

Got it!

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