Did you experienced any side effects?
We need to understand any problems you may have or have had with weight loss medication
Yes
No
What is your current level of exercise on a weekly basis?
Less than 30 minutes
30–60 minutes
60-90 minutes
90-119 minutes
120 minutes or more
What is your current weight?
Metric
Imperial
Weight (Stones)*
(lbs)*
Would you like to change your dosage?
Yes, I would like to increase it
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No, keep it the same
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Yes, I would like to decrease it
Have you received any new medical diagnoses or changes in your current medications?
When did you or will you administer the last dose?
Submit