Consultation - Chemist 69

Weight Loss

Weight loss refers to the reduction of body weight, typically through a combination of diet, exercise, and lifestyle modifications. It is often pursued for health reasons, such as reducing the risk of chronic diseases like diabetes, heart disease, and certain cancers, as well as improving overall well-being and quality of life. Effective weight loss strategies focus on creating a calorie deficit, where the number of calories consumed is less than the calories expended. This can be achieved through diet changes and regular exercise. Sustainable weight loss involves making gradual and lasting changes to eating and exercise habits, as well as addressing emotional and behavioural factors that contribute to overeating or sedentary lifestyles.

Please fill out the form below so that our clinicians can determine if the treatment will be suitable for you to take.

1 About Your Health

Your health and safety are our top priorities. Please provide accurate and complete information during your consultation so we can recommend the most appropriate treatment for you.

Question 1:What is your date of birth?

Question 2:What is your gender?

Female

Male

Question 3:Do you have any known allergies?

Question 4:Do you have any chronic conditions? (e.g., diabetes, hypertension, asthma, etc.)

If yes, please detail them here, otherwise please type N/A

Question 5:Are you currently taking any medications?

If yes, please detail them here, otherwise please type N/A

Question 6:Have you had any surgeries in the past year?

If yes, please detail them here, otherwise please type N/A

Question 7:Do you smoke?

Question 8:Do you consume alcohol?

If yes, how much a day/weekly?

Question 9:What is your typical diet like? (e.g., balanced, high-fat, spicy foods)

Question 10:How often do you exercise? (e.g., daily, weekly, rarely, never)

2 About Your Condition

Please provide accurate and honest details during your consultation. This helps us offer the safest and most effective treatment for you.

Question 1:Please calculate your current BMI.

Please select either Metric or Imperial measurements :

Metric (Centimeters and Kilograms)

Imperial (Feet and Pounds)

Height

Feet

Inches

Weight

Stone

Pound

BMI Calculation:

Question 2:What are your weight loss goals? (e.g., lose a certain number of pounds/kilograms, achieve a specific BMI)

Question 3:Have you tried to lose weight before?

Question 4:What has been your experience with previous weight loss attempts? (e.g., successful, temporary weight loss, no weight loss)

Question 5:Are you currently experiencing any symptoms that may be related to your weight? (e.g., joint pain, shortness of breath, fatigue)

Question 6:Have you been diagnosed with any conditions that could affect your weight or ability to lose weight? (e.g., metabolic syndrome, hypothyroidism)

Question 7:Have you had any tests to evaluate your condition? (e.g., blood tests, metabolic tests)

Question 8:Have you been prescribed medication for weight loss before?

Question 9:Are you currently taking any medication for weight loss?

Question 10:Have you experienced any side effects from your current or past weight loss medications?

Question 11:Have you tried any non-medication treatments for weight loss? (e.g., lifestyle changes, dietary adjustments, physical therapy)

Question 12:Have you used over-the-counter treatments for weight loss?

3 The Agreement and Consent

Please read the Agreement and Consent statements carefully during your consultation. They contain important information to help you stay informed and safe throughout your treatment.

Question 1:Understanding of Risks

Yes

Question 2:Medical Guidance

Yes

Question 3:Consent to Share Information

Yes

Question 4:Confirmation

Yes

Question 5:Video Consultation

Due to new regulations, we are required to have a 5-minute video call to verify your weight before we can supply weight loss treatment.

Once you place your order, we will email you to book a call with our specialist via FaceTime, WhatsApp Video, Google Meet, Microsoft Teams, or Zoom.

Please confirm that you understand and are happy to proceed with this requirement.

1 About Your Health
2 About Your Condition
3 The Agreement and Consent

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TEST CONDITION

Weight Loss

Travel Clinic

Assessment for Weight Loss

Weight Loss

1 About Your Health

Question 1:What is your date of birth?

Question 2:What is your gender?

Question 3:Do you have any known allergies?

Yes

Question 4:Do you have any chronic conditions? (e.g., diabetes, hypertension, asthma, etc.)

Yes

Question 5:Are you currently taking any medications?

Yes

Question 6:Have you had any surgeries in the past year?

Yes

Question 7:Do you smoke?

Yes

Question 8:Do you consume alcohol?

Yes

Question 9:What is your typical diet like? (e.g., balanced, high-fat, spicy foods)

Yes

Question 10:How often do you exercise? (e.g., daily, weekly, rarely, never)

Yes

2 About Your Condition

Question 1:Please calculate your current BMI.

Height

Weight

Height

Weight

Question 2:What are your weight loss goals? (e.g., lose a certain number of pounds/kilograms, achieve a specific BMI)

Question 3:Have you tried to lose weight before?

Yes

Question 4:What has been your experience with previous weight loss attempts? (e.g., successful, temporary weight loss, no weight loss)

Question 5:Are you currently experiencing any symptoms that may be related to your weight? (e.g., joint pain, shortness of breath, fatigue)

Yes

Question 6:Have you been diagnosed with any conditions that could affect your weight or ability to lose weight? (e.g., metabolic syndrome, hypothyroidism)

Yes

Question 7:Have you had any tests to evaluate your condition? (e.g., blood tests, metabolic tests)

Yes

Question 8:Have you been prescribed medication for weight loss before?

Yes

Question 9:Are you currently taking any medication for weight loss?

Yes

Question 10:Have you experienced any side effects from your current or past weight loss medications?

Yes

Question 11:Have you tried any non-medication treatments for weight loss? (e.g., lifestyle changes, dietary adjustments, physical therapy)

Yes

Question 12:Have you used over-the-counter treatments for weight loss?

Yes

3 The Agreement and Consent

Question 1:Understanding of Risks

Question 2:Medical Guidance

Question 3:Consent to Share Information

Question 4:Confirmation

Question 5:Video Consultation

Assessment Progress

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