Weight Loss Clinic (online) Proceed with Treatment

Skinny Minny Shots

To proceed with our online Weight Loss Clinic you will be required to complete and return two forms along with making payment.

We will take a full medical history from you and assess your BMI from your height and weight. This information, which must be truthful and accurate, will be passed to our medical prescriber, who will, in turn, issue a prescription. In case of any query, the prescriber will get in touch with you by phone or email.

By completing and emailing these forms and providing payment you have understood the information detailed on the Weight Loss Clinic page and you certify that the information you have given is truthful and accurate, that you have not withheld any of your medical history and that you are over 18 years of age and under 75 years of age.

Medical Treatment Form and Client Consent and Declaration Form for Treatment

Please list your treatment here.
Each box you tick means you consent. Un-ticked boxes means you do not consent.
Please add your name to act as your signature
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