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Medical Assessment for Weight Loss

To help us supply you with the most suitable treatment, please complete this online consultation.

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Weight Assessment

Please ensure you enter accurate height and weight details as this may affect future prescribing decisions

Enter your height:

Enter your weight:

Do you suffer from diabetes, heart disease, high blood pressure or high cholesterol?
 Your BMI is currently  and you are not eligible for treatment. 
 Your BMI is currently  and you are not eligible for treatment. We advise patients with BMI above 60.0 to contact our customer support or to consult their GP.
 Your BMI is currently  and has  from since you have first ordered Orlistat. To continue using Orlistat you need to lose at least 5% of your weight and so we are unable to continue your treatment. We recommend you speak to your GP for other options to help with your weight loss management. Contact customer support for further information.
 The height you have entered is either too short or too tall - if this height is correct please contact us.
 You must enter a valid height and weight 
 Please complete the question 
About You
Are you aged between 18-80?
    We are unable to supply you with treatment. Please consult your GP or doctor.
    Please complete this question.
    Your Health
    Are you allergic to orlistat?
      We are unable to supply you with weight loss treatment. Please consult your GP or doctor.
      Please complete this question.
      Are you pregnant or breastfeeding or intending to become pregnant or start breastfeeding whilst taking medication?
        We are unable to supply you with weight loss treatment. Please consult your GP or doctor.
        Please complete this question.
        Have you been diagnosed with any of the following?
        • Problems absorbing food (chronic malabsorption syndrome) diagnosed by a GP
        • Liver problems
        • Kidney problems
        • Thyroid problems
        • Surgery to remove your gallbladder (cholecystectomy)
        • Cholestasis (condition where the flow of bile from the liver is blocked)
        • Any serious medical condition which may require immediate hospitalisation
        We are unable to supply you with weight loss treatment. Please consult your GP or doctor.
        Please complete this question.
        Have you ever suffered from an eating disorder such as Anorexia Nervosa or Bulimia?
          We are unable to supply you with weight loss treatment. Please consult your GP or doctor.
          Please complete this question.
          Your Medication
          Are you currently taking any over-the-counter or prescription medication or any recreational drugs?
          Are you taking any of the following medications?
          • Other weight loss treatments
          • HIV medication
          • Fat-soluble vitamins
          • Oral anticoagulant drugs used to thin the blood such as Warfarin
          • Ciclosporin (used after organ transplants, for severe rheumatoid arthritis and some severe skin conditions)
          • Thyroid Medicine (levothyroxine)
          • Iodine salts
          • Amiodarone (used for heart rhythm problems)
          • Acarbose (an anti-diabetic drug used to treat type 2 diabetes mellitus)
          • Anticonvulsant/anti-epileptic drugs
          • Antidepressants
          • Antipsychotics including lithium
          • Benzodiazepines including diazepam
          We are unable to supply you with treatment. Please consult your GP or doctor for more information.
          Please complete this question.
          Are you taking any medicine for high cholesterol, diabetes or high blood pressure?
          You must speak to your GP or doctor to discuss the dosage of your medicine when your weight changes.
          Please complete this question.
          Are you using an oral contraceptive?
          Orlistat can reduce the absorption of oral contraceptives and therefore reduce their effectiveness and increase the risk of their failure. You should use additional forms of contraception whilst taking orlistat.
          Please complete this question.
          Agreement
          Do you understand that the treatment must be stopped once your BMI goes below 28?
            We are unable to supply you with weight loss treatment. If you do not understand this, call our customer support for assistance.
            Please complete this question.
            Do you understand that treatment cannot be continued if you gain weight 3 months after starting the treatment?
              We are unable to supply you with weight loss treatment. If you do not understand this, call our customer support for assistance.
              Please complete this question.
              Do you understand that you should take a multivitamin that contains vitamins D, E, and K and beta carotene? It should be taken once a day at least 2 hours before or after taking Orlistat (Xenical/Alli/Orlos) such as at bedtime.
                We are unable to supply you with weight loss treatment. If you do not understand this, call our customer support for assistance.
                Please complete this question.
                Do you understand the treatment should be taken with a nutritionally balanced, calorie-controlled diet that contains approximately 30% of the calories from fat? It is recommended that your diet is rich in fruit and vegetables.
                  We are unable to supply you with weight loss treatment. If you do not understand this, call our customer support for assistance.
                  Please complete this question.
                  Do you agree to the following?
                  • You will read the patient information leaflet supplied with your medication
                  • You will contact us and inform your GP of your medication if you experience any side effects of treatment, you start new medication and/or your medical conditions change during treatment
                  • The treatment is solely for your own use
                  • You have answered all the above questions accurately and truthfully
                  • You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health
                  • You understand that whilst decisions relating to your treatment are made jointly between you and the prescriber, the final decision to issue a prescription will always be with the prescriber
                  You must agree to this before continuing. If you need assistance contact our customer support.
                  Please complete this question.
                  Complete our 2 minute questionnaire
                  We’re almost done!
                  Ana Carolina Osorio De Faria Goncalves
                  To find a treatment suitable for you, we just need you to answer a few questions.
                  Ana Carolina Goncalves
                  Superintendent Pharmacist
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                  We're so confident you won't find your treatment cheaper, that if you do, we'll refund the difference for up to 14 days!

                  Need help?

                  If you need help with this medical assessment, contact our helpline:

                  0207 112 9014

                  or email us:

                  help@pharmica.co.uk
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