Step 1 - Assessment

Fill out a short questionnaire below to get started on your weight loss journey. Our team of clinicians will review the information provided and be in touch with your treatment options, please allow up to 24 hours for this process. We usually contact you via email so please check your junk inbox if you haven’t received confirmation.

For more information on how we process your data, please refer to our Privacy Policy.

Application Form

Eligibility Form

Full Name

Contact Number

Email Address

Home Address (for delivery)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date Of Birth

YYYY

Gender (as assigned at birth)

Current weight (in Kg or Stone)

Height (in cm or feet)

Have you been diagnosed with diabetes?

Diabetes treatments can impact the way the medication included with our weight loss plan works.

Do you suffer from any of the following conditions?

If you take any medications, please list them below:

Please list any allergies you have (medications, food etc.)

How did you hear about us?

If you were referred by a friend, please give their name below

What To Expect

Simple Assessment

Fill out our online application form. If eligible, you’ll receive confirmation within a day and have you medication posted to you the same day.

Start Treatment

Inject one dose per week. Each month, aim to increase the dose as your body gets used to the medication.

Healthy Weight Loss

You’ll start seeing results quickly. Most of our patients lose up to 10% of their body weight in the first 3 months.

Step 1 - Assessment

Application Form

What To Expect

Simple Assessment

Start Treatment

Healthy Weight Loss

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