Do you agree and consent to the following?

  1. You are completing this consultation for yourself and to the best of your knowledge.
  2. You will disclose any medical conditions, serious illnesses or operations you have had.
  3. You will disclose any prescription medications you are currently taking and agree to use only one weight loss treatment at a time.
  4. You agree to our Terms & Conditions, Terms of Sale, and confirm that you have read our Privacy Policy.
  5. Your accurate and honest responses to this online questionnaire for weight loss treatment are crucial. Withholding or providing false information can severely harm your health and may result in life-threatening consequences. By filling out this questionnaire, you confirm that your responses are truthful and accurate, acknowledging the potential risks of misinformation.
  6. You agree to undergo identification and age verification. This may require submitting valid documents to our approved third-party verification partner for validation.
  7. You consent to EveryDayMeds accessing your Summary Care Record (SCR) for the purpose of ensuring the safe supply of treatment. If the SCR is unavailable or incomplete, you agree to participate in appropriate two-way communication (e.g. phone, secure message, or video consultation) to verify your medical history. If you do not respond or engage, your order will be cancelled.

Your Health

  • Any heart condition, including narrowed arteries (ischaemic heart disease)
  • Chest pain (angina) or previous heart attack
  • Stroke or mini-stroke (TIA)
  • High blood pressure
  • Coronary artery spasms (e.g. Prinzmetal’s angina)
  • Abnormal heart rhythm (Wolff-Parkinson-White Syndrome)
  • Poor circulation (Peripheral Vascular Disease)
  • Previous damage to the gut or spleen (e.g. infarction)
  • Inflammation of the colon due to poor blood flow (ischaemic colitis)
  • Epilepsy or a history of seizures
  • Liver disease or liver problems
  • Kidney disease or kidney problems
  • Allergy to sulphonamide antibiotics (e.g. trimethoprim)
  • Any serious health condition that could require urgent hospital treatment

Medical Condition

  • Weakness or heaviness in one side of the body (e.g. arms or legs)
  • Double vision
  • Poor coordination or clumsiness
  • Ringing in the ears (tinnitus)
  • Feeling faint or losing consciousness
  • Seizure-like movements (fits)
  • A new rash appearing alongside your headache
  • Headache pain mainly at the back of your head
  • A recent noticeable change in your migraine attacks (e.g. more frequent, more severe, or lasting longer)

Medication

Agreement

  • Read patient information leaflet
  • Use the medication personally only
  • Inform GP or service if starting new medicines or experiencing side effects
  • Answered all questions truthfully
  • Understand prescriber makes final decision

GP Consultation

We can notify your GP of your treatment for you. To do so, we need their contact information. Sharing this information allows your GP to maintain a comprehensive record of your medical history, which is crucial for your health. Without complete records, there could be potential risks to your well-being.