Weight loss repeat form

Have you noticed any of the following thyroid symptoms?

Lump or swelling in your neck

Hoarseness

Difficulty swallowing

New shortness of breath

None of the symptoms above

What is your weight as of today?

How much weight have you lost since last month?

Are you keeping up with a diet plan?

Yes

Sometimes

Are you keeping up with your excersize plan

Yes

Sometimes

Did you get any other side effects, please type them out below

Did you experience any severe pain in your stomach area that did not go away?

Yes

Did you experience any changes in your vision?

Yes

Did you tolerate the medicine well?

Yes very minimal side effects

The side effects were a concern

Are you planing to become pregnant or could you already be pregnant?

Yes

SAFETY NOTICE Please note your risk of Low blood sugar will increase by taking this medicine with another medicine that reduces blood sugar such as metformin or gliclazide, so please be aware of the following signs and symtomps of low blood sugar;

dizziness or lightheadedness
blurred vision
anxiety, irritability, or mood changes
sweating
slurred speech
hunger
confusion or drowsiness
shakiness
weakness
headache
fast heartbeat
feeling jittery

SAFETY NOTICE people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems to get worse

SAFETY NOTICE

serious allergic reactions. Stop using Ozempic^® and get medical help right away if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat.

Are you confident with the correct injection technique?

Yes

Please see here a video of how to use the pen if you are unsure or would like a reminder.

Has your weight loss with this medication been positive, please describe your journey?

I confirm;

I have read all of the above safety notices

I will notify my GP of any of the side effects stated above

I will stop taking the medicine if i develop any thyroid symptoms stated above

I will store this medication if the fridge that is between 2-8 degrees

I have watched the video and understand how to use the pen

I will dispose my needles safely in a yellow sharp bin