GlowSlim Patient Consultation Form



2. Have you previously received a weight-loss
prescription from us?


I am completing this consultation for myself and to the best of my knowledge.

I will disclose all medical conditions, serious illnesses or operations I have had.

I will disclose all prescription medication I currently take.

I understand only one weight-loss treatment can be used at a time.

I understand I may be prescribed an unlicensed/off-label medication.

I understand my health data may be used for clinical safety, planning and marketing (optional opt-out available).

You consent to an age and ID Check when placing your first order.