Weight Loss

Complete this short assessment so our prescribers can determine if treatment is right for you.

Takes approximately 5 minutes
Step 1 of 2 50% About 5 min left
1
Acknowledgement
2
About You and Your Health

1 Acknowledgement

These questions are designed to help us understand how you will use the medication we may prescribe for you. Should you require assistance completing this form then please contact a member of our Customer Care team.

Please Note: If this is your first time taking this medication, you will only be allowed to order the initial strength for Mounjaro (2.5mg) and Wegovy (0.25mg). Following the initial dose, subsequent orders will be increased in strength using a stepwise approach.

2 About You and Your Health

These questions help us understand who you are and your current health.

Weight
Height
Only images are accepted.
Weight
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