Weight Management Questionnaire

We hope to support you on your journey

Below are some questions so we can assess whether we can help you.

This questionnaire is like a consultation. After completing the questionnaire, we will arrange a meeting with our practitioner to issue the appropriate treatment.

On average this questionnaire takes 7 minutes to complete.

If you prefer to book an appointment without filling the questionnaire, then no problem! Use our appointment booking service to speak to one of our clinicians.

Section 1 - Declaration

By proceeding and submitting the questionnaire, you confirm that you:

Check all eight boxes to proceed: *

Are completing this questionnaire for yourself and to the best of your knowledge *
Will disclose any medical conditions, serious illnesses or operations you have had *
Will only use one prescribed weight loss treatment at a time *
Are aware that you may be prescribed off-label treatment *
Will disclose any prescription medication you currently take *
Will complete ID verification *
Are registered with a GP practice in the UK *
Accept Prosper Healthcare Terms and Conditions *

We hope to support you on your journey

Section 1 - Declaration

Section 2 - Information About You

Section 3 - Suitability of Treatment