Consultation - Mentor Pharmacy

1 Getting Started

Let’s begin with a few quick questions to check if this treatment may be suitable for you.

Before we begin, please confirm the following:

I am between 18 and 75 years old and live in the United Kingdom.
I am completing this consultation for myself, and the information I provide will be accurate to the best of my knowledge.
If treatment is prescribed, it will be for my personal use only, and I will not use more than one weight-loss medication at the same time.
I understand that a qualified prescriber will review my answers, and treatment may not be suitable for me.

I confirm

2 Weight Loss Goals & History

What made you start looking for weight loss treatment today?

Select all that apply.

I want to improve my health

I want to feel more confident

I’ve struggled to lose weight with diet or exercise

A healthcare professional suggested it

I want extra support with weight loss

3

What's your height and weight?

Please select either Metric or Imperial measurements :

Metric (Centimeters and Kilograms)

Imperial (Feet and Pounds)

Height

Feet

Inches

Weight

Stone

Pound

BMI Calculation:

4 Your Weight Loss Journey

Tell us a little about your previous experience with weight management.

Have you used any weight loss medications before?

If you have used GLP-1 medication (Mounjaro, Wegovy, or Ozempic) for at least one month, select "yes."

Yes

5

Which weight loss medication have you used?

6

7

Where did you last receive your weight loss medication from?

My GP or NHS prescription

A pharmacy in person (for example Boots or Lloyds)

An online pharmacy (for example MedExpress or Simple Online Pharmacy)

An online weight loss clinic (for example Voy, Juniper, Numan)

A private doctor or clinic

Other

Prefer not to say

8

9

Please upload evidence of current dosage

If you are requesting a higher strength as your starting dose, please provide proof of your current dosage by uploading an image of the label on the box or a copy of your most recent prescription. Without evidence of your previous dose, our prescriber may be unable to issue a higher dose as requested.

If you have not used any medicine before, skip this question and move on to the next.

Only images are accepted.

Image #1

10 Your Health

We need to check a few medical details to ensure treatment is safe for you.

What is your goal weight?

Weight

lbs

Stone

Pounds

11

What is your gender at birth?

Male

Female

12

Are you currently pregnant, breastfeeding, or planning to become pregnant?

Yes

13

Pregnancy and Contraception:

These medications must not be used if you are pregnant or planning to become pregnant.
If you are sexually active and could become pregnant, you should use effective contraception during treatment.
For people taking Mounjaro or Orlistat, we recommend using a non-oral method of contraception, such as condoms or an intrauterine device (coil).
If you use the oral contraceptive pill, you should also use an additional method of contraception while taking this medication. This is because treatment may affect how well the pill is absorbed and could reduce its effectiveness.
Please contact us straight away if you become pregnant or plan to try for pregnancy while using this treatment.

I understand

I do not wish to continue

14

With which ethnic group do you primarily identify?

Why do we ask this? Optimal Body Mass Index (BMI) ranges may vary based on an individual's ethnic background.

15

Do you take any regular medications?

Yes

17

Please list any medicines you are currently taking

Include prescriptions, over-the-counter medicines and injections or weight loss treatments.

20

Do you have any allergies to medicines or medication ingredients?

Yes

21

Which of the following are you allergic to?

22

Please describe your allergy

23

Have you had weight loss surgery in the past?

Yes

24 Lifestyle

Your lifestyle helps our prescribers recommend the most suitable treatment.

How would you describe your activity level?

Sedentary (little or no exercise)

Lightly active

Moderately active

Very active

25

How would you describe your typical diet?

26

Do you currently smoke or use nicotine products?

27 Almost There

Just a few final questions before your consultation is submitted.

How often do you drink alcohol?

28 GP Information

Can we inform your GP about any treatment prescribed as part of this consultation?

Sharing this information helps ensure your GP has an up-to-date record of your care.

Yes, you can inform my GP

No, I would prefer that you do not contact my GP

I am not currently registered with a UK GP

29 Verification & Identity Check

Please confirm you understand the verification steps required before your order can be reviewed

Before your consultation can be reviewed, we may need to verify some information to ensure treatment is safe and appropriate.

This may include:

Verification photos – a recent body photo and confirmation of your current weight.
A short video consultation – to confirm your identity using a valid photo ID.

These steps help ensure safe prescribing and prevent misuse of prescription weight-loss medications.

Please note:

Your order is not automatically approved after submitting this consultation.
Your order cannot be reviewed until any requested verification steps are completed.

I understand

30

If you would like to speed up the review process, you may upload the following now. If not provided, we may request them later.

Upload a recent body photo (front view)

Body photo instructions:

Take a recent photo of yourself standing and facing the camera.
Your full body should be visible from head to knees.
Wear normal or loose clothing (gym wear or everyday clothing is fine).
Your face does not need to be visible if you prefer.
The photo should be clear and taken in good lighting.

Only images are accepted.

Image #1

31

Upload proof of your current weight (scale photo or app screenshot)

Weight confirmation photo instructions:

Take a photo of your current weight displayed on a scale.
The number on the scale must be clearly visible.
You may also upload a screenshot from a smart scale or health app showing your weight.
The image must be recent and clearly readable.

Only images are accepted.

Image #1

32 Lastly – Your Confirmation

Before submitting your consultation, please confirm the following:

I will read the Patient Information Leaflet provided with any medication prescribed.
I understand that all medications can cause side effects, and I will seek medical advice if I experience any concerning symptoms.
I will inform the clinical team of any new medical conditions, medications, or changes to my health while using treatment.
I confirm that I have disclosed all relevant medical conditions, past illnesses, surgeries, and medications.
I agree that my GP may be informed about my treatment where appropriate to support safe care.
I understand that clinicians may need to review my medical history if necessary to ensure safe prescribing.
I confirm that I have read and agree to the Terms of Use, Terms of Sale, Privacy Policy, and Cancellation & Refund Policy.

I confirm

Acne

Asthma

Contraceptives

Eczema and Dermatitis

Erectile Dysfunction

Hay Fever

Menopause

Shingles

Urinary Tract Infection (UTI)

Ear Wax Removal

Private Blood Tests

Assessment for Acid Reflux

1 Getting Started

Before we begin, please confirm the following:

2 Weight Loss Goals & History

What made you start looking for weight loss treatment today?

3

What's your height and weight?

Height

Weight

Height

Weight

4 Your Weight Loss Journey

Have you used any weight loss medications before?

5

Which weight loss medication have you used?

6

Which other weight loss medication have you used?

7

Where did you last receive your weight loss medication from?

8

Please tell us where you received your medication

9

Please upload evidence of current dosage

10 Your Health

What is your goal weight?

11

What is your gender at birth?

12

Are you currently pregnant, breastfeeding, or planning to become pregnant?

13

Pregnancy and Contraception:

14

With which ethnic group do you primarily identify?

15

Do you take any regular medications?

16

Are you taking any of the following medications?

17

Please list any medicines you are currently taking

18

Do you currently have, or have you ever been diagnosed with any of the following conditions?

19

Have you ever been diagnosed with any of the following health conditions?

20

Do you have any allergies to medicines or medication ingredients?

21

Which of the following are you allergic to?

22

Please describe your allergy

23

Have you had weight loss surgery in the past?

24 Lifestyle

How would you describe your activity level?

25

How would you describe your typical diet?

26

Do you currently smoke or use nicotine products?

27 Almost There

How often do you drink alcohol?

28 GP Information

Can we inform your GP about any treatment prescribed as part of this consultation?

29 Verification & Identity Check

Please confirm you understand the verification steps required before your order can be reviewed

30

Upload a recent body photo (front view)

31

Upload proof of your current weight (scale photo or app screenshot)

32 Lastly – Your Confirmation

Before submitting your consultation, please confirm the following: