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weight loss prescriber form
Name of prescriber
Professional regulatory body number (PIN)
Who is your regulatory body?
Does your insurance cover prescribing for weight loss?
Please upload a screenshot of your insurance that covers weight loss
Please upload a screenshot of any certificates you have for weight loss training
Do you understand the medical risks linked to saxenda and ozempic?
I consent to all of the following:
I will prescribe this medication after a consultation with each of the clients
I will assess the mental health of the patients to ensure there is no sign of anorexia, bulimia, eating disorders or any sign of abuse
I will carry out identity checks on each of my clients to ensure I am prescribing for the person on the prescription.
I will take responsibility for notifying the GP of the patients precription choices
The patients will be guided on how to correctly use the weight loss injections
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