Weight Loss Consultation Summary
General Information
Gender
{Are you a male or female?:15}
Are you a male or female?
Pregnancy
{Are you pregnant, breastfeeding or trying to get pregnant?:16}
Are you pregnant, breastfeeding or trying to get pregnant?
Date of Birth
{What is your date of birth?:17}
What is your date of birth?
You are 18 years or older
{Do you confirm that:18}
You are 18 years or older?
Height
{Meter:67} m {Centimeters:43} cm
What is your height?
Weight
{KG:50} kg
What is your weight?
BMI
{BMI:121}{BMI:122}
Your Body Mass index is
Medical Information
Medicine for weight loss
{Are you currently taking or have you ever taken any medicine to help with weight loss?:21}
Are you currently taking or have you ever taken any medicine to help with weight loss?
Daily Calories Consumption
{How many calories do you think you consume daily?:133}
How many calories do you think you consume daily?
Medication for Diabetes
{Are you taking any medication for diabetes, e.g. Insulin, GLP-1 receptor agonists or Sulphonylurea?:26}
Are you currently taking insulin or a Sulphonylurea (e.g. Gliclazide or Glimepiride) for diabetes?
Taking a GLP-1
{Are you currently taking a GLP-1 (e.g. Victoza, Trulicity, Byetta, Bydureon, Ozemic)?:142}
Are you currently taking a GLP-1 (e.g. Victoza, Trulicity, Byetta, Bydureon, Ozemic)?
Kidney or Liver problems
{Do you have any kidney or liver problems?:28}
Do you have any kidney or liver problems?
Heart Problem / Stroke
{Have you ever had any cardiovascular (heart problem) or have you ever had a stroke?:30}
Have you ever had any cardiovascular (heart problem) or have you ever had a stroke?
Any Allergies
{Do you have any allergies?:32}
Do you have any allergies?
Medication, Supplements or Vitamins
{Are you currently taking any other prescribed or brought medication, supplements or vitamins?:34}
Are you currently taking any other prescribed or brought medication, supplements or vitamins?
Relevant Health or Medical Information
{Can you think of any other relevant health or medical information that you feel we should know about?:36}
Can you think of any other relevant health or medical information that you feel we should know about?
Weight Loss Consultation Summary
General Information
Gender
{Are you a male or female?:15}
Are you a male or female?
Pregnancy
{Are you pregnant, breastfeeding or trying to get pregnant?:16}
Are you pregnant, breastfeeding or trying to get pregnant?
Date of Birth
{What is your date of birth?:17}
What is your date of birth?
You are 18 years or older
{Do you confirm that:18}
You are 18 years or older?
Height
{Feet:115} ft. {Inches:116} in
What is your height?
Weight
{KG:50} kg
What is your weight?
BMI
{BMI:121}{BMI:122}
Your Body Mass index is
Medical Information
Medicine for weight loss
{Are you currently taking or have you ever taken any medicine to help with weight loss?:21}
Are you currently taking or have you ever taken any medicine to help with weight loss?
Daily Calories Consumption
{How many calories do you think you consume daily?:133}
How many calories do you think you consume daily?
Medication for Diabetes
{Are you taking any medication for diabetes, e.g. Insulin, GLP-1 receptor agonists or Sulphonylurea?:26}
Are you currently taking insulin or a Sulphonylurea (e.g. Gliclazide or Glimepiride) for diabetes?
Taking a GLP-1
{Are you currently taking a GLP-1 (e.g. Victoza, Trulicity, Byetta, Bydureon, Ozemic)?:142}
Are you currently taking a GLP-1 (e.g. Victoza, Trulicity, Byetta, Bydureon, Ozemic)?
Kidney or Liver problems
{Do you have any kidney or liver problems?:28}
Do you have any kidney or liver problems?
Heart Problem / Stroke
{Have you ever had any cardiovascular (heart problem) or have you ever had a stroke?:30}
Have you ever had any cardiovascular (heart problem) or have you ever had a stroke?
Any Allergies
{Do you have any allergies?:32}
Do you have any allergies?
Medication, Supplements or Vitamins
{Are you currently taking any other prescribed or brought medication, supplements or vitamins?:34}
Are you currently taking any other prescribed or brought medication, supplements or vitamins?
Relevant Health or Medical Information
{Can you think of any other relevant health or medical information that you feel we should know about?:36}
Can you think of any other relevant health or medical information that you feel we should know about?
Weight Loss Consultation Summary
General Information
Gender
{Are you a male or female?:15}
Are you a male or female?
Pregnancy
{Are you pregnant, breastfeeding or trying to get pregnant?:16}
Are you pregnant, breastfeeding or trying to get pregnant?
Date of Birth
{What is your date of birth?:17}
What is your date of birth?
You are 18 years or older
{Do you confirm that:18}
You are 18 years or older?
Height
{Feet:115} ft. {Inches:116} in
What is your height?
Weight
{Stones:117} st. {Pounds:69} lb
What is your weight?
BMI
{BMI:121}{BMI:122}
Your Body Mass index is
Medical Information
Medicine for weight loss
{Are you currently taking or have you ever taken any medicine to help with weight loss?:21}
Are you currently taking or have you ever taken any medicine to help with weight loss?
Daily Calories Consumption
{How many calories do you think you consume daily?:133}
How many calories do you think you consume daily?
Medication for Diabetes
{Are you taking any medication for diabetes, e.g. Insulin, GLP-1 receptor agonists or Sulphonylurea?:26}
Are you currently taking insulin or a Sulphonylurea (e.g. Gliclazide or Glimepiride) for diabetes?
Taking a GLP-1
{Are you currently taking a GLP-1 (e.g. Victoza, Trulicity, Byetta, Bydureon, Ozemic)?:142}
Are you currently taking a GLP-1 (e.g. Victoza, Trulicity, Byetta, Bydureon, Ozemic)?
Kidney or Liver problems
{Do you have any kidney or liver problems?:28}
Do you have any kidney or liver problems?
Heart Problem / Stroke
{Have you ever had any cardiovascular (heart problem) or have you ever had a stroke?:30}
Have you ever had any cardiovascular (heart problem) or have you ever had a stroke?
Any Allergies
{Do you have any allergies?:32}
Do you have any allergies?
Medication, Supplements or Vitamins
{Are you currently taking any other prescribed or brought medication, supplements or vitamins?:34}
Are you currently taking any other prescribed or brought medication, supplements or vitamins?
Relevant Health or Medical Information
{Can you think of any other relevant health or medical information that you feel we should know about?:36}
Can you think of any other relevant health or medical information that you feel we should know about?
Weight Loss Consultation Summary
General Information
Gender
{Are you a male or female?:15}
Are you a male or female?
Pregnancy
{Are you pregnant, breastfeeding or trying to get pregnant?:16}
Are you pregnant, breastfeeding or trying to get pregnant?
Date of Birth
{What is your date of birth?:17}
What is your date of birth?
You are 18 years or older
{Do you confirm that:18}
You are 18 years or older?
Height
{Meter:67} m {Centimeters:43} cm
What is your height?
Weight
{Stones:117} st. {Pounds:69} lb
What is your weight?
BMI
{BMI:121}{BMI:122}
Your Body Mass index is
Medical Information
Medicine for weight loss
{Are you currently taking or have you ever taken any medicine to help with weight loss?:21}
Are you currently taking or have you ever taken any medicine to help with weight loss?
Daily Calories Consumption
{How many calories do you think you consume daily?:133}
How many calories do you think you consume daily?
Medication for Diabetes
{Are you taking any medication for diabetes, e.g. Insulin, GLP-1 receptor agonists or Sulphonylurea?:26}
Are you currently taking insulin or a Sulphonylurea (e.g. Gliclazide or Glimepiride) for diabetes?
Taking a GLP-1
{Are you currently taking a GLP-1 (e.g. Victoza, Trulicity, Byetta, Bydureon, Ozemic)?:142}
Are you currently taking a GLP-1 (e.g. Victoza, Trulicity, Byetta, Bydureon, Ozemic)?
Kidney or Liver problems
{Do you have any kidney or liver problems?:28}
Do you have any kidney or liver problems?
Heart Problem / Stroke
{Have you ever had any cardiovascular (heart problem) or have you ever had a stroke?:30}
Have you ever had any cardiovascular (heart problem) or have you ever had a stroke?
Any Allergies
{Do you have any allergies?:32}
Do you have any allergies?
Medication, Supplements or Vitamins
{Are you currently taking any other prescribed or brought medication, supplements or vitamins?:34}
Are you currently taking any other prescribed or brought medication, supplements or vitamins?
Relevant Health or Medical Information
{Can you think of any other relevant health or medical information that you feel we should know about?:36}
Can you think of any other relevant health or medical information that you feel we should know about?
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