Step 1: Health Questions – Orlistat Consultation | Kings Pharmacy Online
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Step 1 of 3
Health Questions
Please answer the following questions so we can assess your suitability for Orlistat treatment
Are you aged over 18?
*
Yes
No
Please enter your height for BMI calculation
*
Centimetres
Switch to ft, in
Feet
Inches
Please enter your weight (for BMI calculation)
*
Please note, we may contact you to ask you to provide evidence of your current weight
Kilograms
Switch to st, lb
Stone
Pounds
Your calculated BMI:
People with weight-related medical conditions might be prescribed this medication at a lower BMI than others, if appropriate. Do you have any of the following weight-related conditions?
*
Non-alcoholic fatty liver disease
Non-alcoholic steatohepatitis (NASH)
On treatment for Depression linked to your weight
Cardiovascular disease (such as heart attack, Atrial Fibrillation)
Knee or hip osteoarthritis
Asthma
COPD
Obstructive sleep apnoea
Pre-diabetes
Polycystic ovary syndrome (PCOS)
Yes
No
Please tell us which condition(s) apply to you
Are you currently using any weight loss medication?
*
Yes
No
Are you aware that you should only be using one weight loss medication at a time? You must not use two weight loss medications at the same time.
*
Agree
Continue to Step 2
