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Online Consultation

Please answer all questions honestly and completely so our health professional can ensure suitability and prevent any delays in supplying your medication

Are you purchasing this medication for yourself?
Are you over 18?
Do you or have you ever suffered from an eating disorder such as Bulimia Nervosa or Anorexia?
Do you have a BMI which is or greater than 28?
What is your weight (please give answer in kilograms)?
What is your height? (please give answer in centimetres)?
Do you have any allergies?
Do you have cholestasis or chronic malabsorption syndrome?
Do you have hepatic or renal impairment?
Do you take any of the following medication?
  • Anticoagulants to thin the blood such as; Aspirin, Clopidogrel, Warfarin, Rivaroxaban
  • Amiodarone
  • Vitamin A, D, E or K supplements
  • Ciclosporin
  • Anti-retroviral medications such as tenofovir, efavirenz, abacavir or emtricitabine
  • Acarbose
Do you have any other medical conditions, take any other medication or recreational drugs?
Have you ever been told by your doctor that you should not take treatment for your condition due to your current medical conditions?
I will read the patient information leaflet before using any provided treatments.
I agree that
  • I will stop my treatment once my BMI falls below 28.
  • I will discontinue treatment if there is no weight loss achieved after 3 months of using orlistat.
  • I will not use this treatment for longer than 6 months continuously.
  • All questions have been answered to the best of my knowledge.
  • I am happy for pharmacists to review my consultation and prescribe the item requested if it is clinically suitable for myself.
  • I understand my treatment request may be rejected due to clinical or other reasons.
  • The treatment is solely for my own use and not for the use of others.
  • I consent for SPK Pharma Ltd to undertake an ID check to confirm my age and identity. (This will be done using a credit check agency, no record will be put on your credit rating).
  • Menschem will not inform my GP of this consultation, unless specifically requested via emailing [email protected] (please include GP name, address, and email address)