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WEIGHT LOSS
PRESCRIPTION REQUEST

PLEASE NOTE THIS PAGE IS FOR PATIENTS CURRENTLY ON OUR WEIGHT LOSS PROGRAM

TO OBTAIN FURTHER PRESCRIPTIONS AND ARRANGE REVIEWS

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As part of our ongoing efforts to ensure the best possible care and track the progress of your treatment, we kindly ask that you complete a brief questionnaire regarding your weight management medication.This is required before your last dose of your current cycle.Your feedback will help us better understand how the medication is working for you and allow us to make any necessary adjustments to your treatment plan.The questionnaire should only take a few minutes of your time and can be completed at your convenience.

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If you have any questions or concerns about the medication or the questionnaire, please do not hesitate to reach out.

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Thank you for your time and cooperation.  We look forward to continuing to support you on your weight management journey.

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