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Pharmacist  in aisle of Pharmacy
Consultation Form

For new customers, please fill out the form below

Why do I need to complete a health form?

 

As some treatments are prescription-only medications, we need to ensure you are safe & suitable to use them. Your information will NEVER be shared with any 3rd party. We only share your information with our pharmacy partners.

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PLEASE NOTE: We will require a form of ID to verify you are over the age of 18 and that we are prescribing for a genuine person. If you have used the medication before & are ordering a higher dose than the first dose, we will require proof of previous usage. If this information is not loaded with your health form, it may cause delays to your order.

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What happens after I have done the form?

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When you submit your form, you will be invited to create a free online account on our website. Your form will be screened by a prescriber and we will contact you with the outcome as soon as we hear. This can take up to 48 hours to process.

Online Health Form

Please fill out the following form to the best of your knowledge. Please note, if you are making payment for your order under a different name / email address, please let us know via the notes below or via email. If there is any information that needs updating after you submit your form, please let us know as soon as possible via email - info@ajhillaesthetics.co.uk

 

Please ensure your shipping address at checkout or on your invoice is correct - this address will automatically go to the courier for delivery. If the address needs amending after an order is placed or paid for but before we have shipped your order, please let us know as soon as possible to avoid an error when delivering.

Your Details

What unit of measurement is your weight?
What is your sex?
Upload File
Upload supported file (Max 15MB)

Your Medical Background:

Do you currently have or have a history of the following conditions (please tick all that apply): Required
Have you ever been diagnosed with: Required
Are you taking any regular medications?
Are you pregnant or currently breast feeding?
Are you actively trying to get pregnant?
Have you ever had surgery under general anesthetic?
Do you have any allergies?

A bit about you...

How many times per week do you currently exercise: Required
How much sleep do you manage to get on an average night? Required
How many units of alcohol do you consume on average in a week? (This tool may help get a more accurate level https://www.drinkaware.co.uk/understand-your-drinking/unit-calculator ) Required
Do you smoke?

Your ID

Treatment Options

Which weight loss treatment option(s) are you interested in? Required
For the Ozempic, Trulicity, & Rybelsus, these items are NOT yet licensed for weight loss and it would be prescribed to you off-label (for another purpose other than its current license)
Have you tried any of these weight loss products before?
Upload File
Upload supported file (Max 15MB)
Would you like to add 30 anti-sickness tablets to your order for £9.99?
Do you have a preference for anti-sickness tablets?
Would you like to add 28 tablets of Omeprazole (for reducinacid reflux) to your order for £10.99?
Do you know if your blood pressure is:
Are you currently taking any of the following mediations? Required
Your package is sent via special delivery for £4.99 & needs to be signed for. What days can you accept deliver? Required
Your item will be sent via DPD unless you request Royal Mail or live in Northern Ireland.

General information:

Delivery Address:

​Please ensure your delivery/shipping address at the payment checkout or on your invoice is the correct address - once shipped, we can no longer amend any errors with the address. Please see our Delivery Policy for further information

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Licensing of the Medication:

​Saxenda (liraglutide), Wegovy (semaglutide) and Mounjaro (tirzepatide) are licensed for weight loss in the UK.

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Ozempic (semaglutide), Rybelsus (semaglutide) and Trulicity (dulaglutide) are NOT yet licensed for weight loss in the UK & EU. They are currently licensed for Type 2 diabetes.

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A medication can be prescribed for a purpose other than it's current license - this is called off-label prescribing. You must be aware and fully informed of this.

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Aftercare:​

Whilst your product will come with a Patient Information Leaflet (PIL), your "My Account" area on the website will have electronic copies of the PIL, our tailor made aftercare booklet, the official medication's booklet (if available) and demo videos to show you how to use your product. If you have any queries, please visit the Contact Us page.

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Contraception:

Please note that there have been clinical studies which suggest these medications may reduce the effectiveness of oral contraception. We advise you to take extra precautions if you are taking oral contraceptive medication when engaging in sexual intercourse.

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Side Effects:

​Everyone is different. You may not experience any side effects, you may experience one side effect or several side effects.

 

The most common side effects associated with this medication are:

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  • Nausea

  • Headaches

  • Dry Mouth

  • Constipation

  • Loose Stool

  • Tiredness

  • Stomach Cramps

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Further information is available via our FAQ page and the aftercare page in the My Account section of the website. Please do not hesitate to contact us if you need any support on dealing with side effects. We are more than happy to advise you.

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Adverse Effects:

​Adverse effects are rare. They may include:​

  • Palpitations / Fast Heart Rate

  • Pancreatitis

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If you experience or feel that you may be experiencing these adverse effects, please stop using the medication & contact 111. When you are safe to do so, please contact us.

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Anaphylaxis:

​There have been no documented cases of an anaphylactic reaction to these medications. ​If you experience swelling of the lips/tongue/throat, difficulty breathing, tightness in the chest, a severe rash or severe itching, discontinue use immediately and call 999.

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Information Sharing:

​You agree to allow AJ Hill Aesthetics to share your information with relevant third parties (e.g. clinics, pharmacies, medical practitioners etc.) solely in relation to your treatment - we will never share your data unnecessarily or with any marketing companies or with any party that is not involved in your treatment.

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Cancellation, Returns & Refunds:

​Please read our policies on delivery, returns, faults and refunds. Any orders placed and screened but not yet dispensed/shipped MUST be cancelled by written communication - there will be a £25 admin fee to cover our expenses. By submitting your form, you agree to the below policies, terms & conditions:

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Your Agreement With Us:

I understand that drinking alcohol during the programme may effect my weight loss results.
I agree to take the medication as advised and directed.
I agree to keep the weight loss medication out of reach of young children at all times and that the medication will solely be used by myself.
I understand & agree that no refunds can be issued once the medication has been dispatched as per our Terms & Conditions.
I agree that I will seek urgent medical attention (999) in the highly unlikely event of an anaphylactic shock
I agree that I will contact my provider (AJ Hill Aesthetics) if I experience difficulty with using or any side effects when using the medication or if I require any additonal support with my weight loss journey.
I understand that the medication does not guarantee weight loss for everyone; my weight loss may be less or more than the average
I agree to access and read the after care information available on the My Account section of the AJ Hill Aesthetics website. This is free to access.
How did you hear about us?

What are the next steps?

REVIEW
We review your form to ensure suitability to use the medication.

payment
Payment is made and the pharmacy will dispense your prescription.

DELIVERY
The pharmacy will deliver to your chosen address.

Delivery Policy  |  Returns & Refunds  |  Privacy Policy

Medicines & Risk Policy  |  Contact Us

Complaints  |  Reporting a Product Fault

 

AJ Hill ® 2025

Registered Company: MH&W Ltd (15203230)

0333 533 9019    info@ajhillaesthetics.co.uk

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Our normal operating hours are:

Mon-Fri 9am-6pm

Sat-Sun 10am-4pm

We may email you outside of these hours.

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AJ Hill is not an online pharmacy - we are an online clinic between patient, prescriber and dispensing pharmacy.
You are forwarded to a UK regulated prescriber for review. If approved, your prescription is then dispensed by a UK registered & regulated pharmacy. AJ Hill Aesthetics will provide you with aftercare, meal plans, exercise plans & ongoing support in conjunction with our pharmacy partners.

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Our current pharmacy partners are:

​​​​​​Acre Pharmacy (GPhC Number: 9011661)​

Teleta Pharmacy (GPhC Number: 9011283)

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