Review Form

Current Weight - Select whether you would like to add your weight in Kgs or St & Ibs*

KgsSt lbs
Current Weight (St & lbs)**
Current Weight (kgs)**
Blood Pressure Reading

For example, 120/80 would be a systolic number of 120 and a diastolic number of 80
Current Blood Pressure Reading - Systolic Number*
Current Blood Pressure Reading - Diastolic Number*
Current Heart Rate*
For female patients - Date of Last Menstrual Period (if applicable)

DayMonthYear
Date
Current Medication (including all medication taken whether prescribed by The Slimming Clinic or not)*
If you are on Saxenda, Mounjaro or Ozempic, Are you happy with your current dose of weight loss medication or would you like to decrease or increase your dose?*
How well is your appetite supressed?*
Describe your current diet*
Do you feel like you are tolerating your current medication?*
Describe your current exercise/activity*
Are you experiencing any side effects?*
Any other comments
Please upload any supporting information you would like your doctor to review, such as a photo of your blood pressure or weight. The file must be a jpeg,png or pdf format

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Type a question*

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