Help us prepare for your appointment by completing this form in advance.
This form includes a brief eating disorder screen (the SCOFF questionnaire) and questions about your weight history and any medications you've tried.
It helps your doctor understand where you are now so the consultation can focus on what comes next. Takes about 5 minutes.
Please enter in kg or stones
Please enter in cm or feet/inches
This is a validated screening tool. Answering honestly helps us assess your safety.
SCOFF screening - 2 or more 'Yes' answers suggests possible eating disorder. This is a screening tool, not a diagnosis.
Select all that apply
ABSOLUTE CONTRAINDICATION - GLP-1 medications cannot be used if you have or have had medullary thyroid cancer, or if it runs in your family.
ABSOLUTE CONTRAINDICATION - GLP-1 medications cannot be used if you have MEN2 or a family history of it.
GLP-1 medications can increase pancreatitis risk. This is a relative concern depending on how many episodes and when.
GLP-1 medications increase the risk of gallbladder problems and gallstone formation.
GLP-1 medications slow stomach emptying and can worsen gastroparesis.
Rapid glucose improvement from GLP-1 can temporarily worsen diabetic retinopathy.
GLP-1 medications should be stopped at least 2 months before conception.
GLP-1 medications for weight loss are not suitable for type 1 diabetes.
GLP-1 medications can affect kidney function. Please provide details if yes.
Hypothyroidism can contribute to weight gain. Weight loss medication may interact with thyroid treatment.
PCOS often causes weight gain and may benefit from specific weight loss approaches.
Steroids cause weight gain and may affect weight loss medication.
Sleep apnoea is linked to weight gain and can be improved by weight loss.
Some weight loss medications have cardiac benefits; others require cardiac assessment first.
Some medications for weight loss can affect mood. We want to make sure the approach suits you.
ADHD can involve impulsive eating. Some ADHD medications affect appetite.
Late-night eating is common and can affect weight loss efforts.
1 unit = small glass of wine, 1 shot spirits, or half a pint of beer
Include type, frequency, and duration
Sedentary time is linked to weight gain and health problems.
Poor sleep is linked to weight gain and increased appetite.
Some medications (antipsychotics, SSRIs, insulin, steroids, beta-blockers) can cause or worsen weight gain.
Anything you would like your doctor to know before your appointment.
Your information is sent securely to your doctor at LoveMyLife. We will not share your details with third parties. By submitting this form, you consent to LoveMyLife contacting you regarding your appointment.