Complete Our Online Assessment

Please provide us with your name?

First Name

Last Name

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What is your mobile number?

Mobile Number

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What is your email address?

Email Address

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What ethnicity are you?

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Are you currently pregnant, trying to get pregnant, or breastfeeding?

Yes

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Have you been diagnosed with diabetes?

I have diabetes and take medication for it

I have diabetes and it's diet controlled

I don't have diabetes

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Please list any other medical conditions you have.

Our clinicians need to know your full medical history to make sure treatment is safe for you to take.

Answer “none” if you don’t have any.

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Do any of the following statements apply to you?

I have been diagnosed with a mental health condition such as depression or anxiety

I have or have an eating disorder such as bulimia, anorexia nervosa, or a binge eating disorder

None of these statements

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Have you ever taken any of the following medications to help you lose weight?

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Can you tell us how long you have been taking this medication and share your experience with it?

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Please indicate whether you are presently using any medication, such as prescription drugs, over-the-counter medications, or supplements, by selecting all that are applicable to you.

I'm on Levothyroxine

I'm on Warfarin

Other / I take more than one prescription medication(if so, please list all medication that you currently take)

I don't take medication

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How did you respond to the medication, and what led you to discontinue its use?

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Have you taken Ozempic, Wegovy, Rybelsus, Saxenda medication in the past 28 days?

Yes

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As you have taken Ozempic, Rybelsus or Saxendamedication in the past 28 days, please provide a photo of your medication.

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Do you have any known allergies? If yes, please list them clearly in the space provided below. If you do not have any allergies, simply state 'none'

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Share with GP

Can you confirm if you would like your GP to be made aware if you are deemed eligible for treatment?

Yes

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Share with GP

Please provide the appropriate GP details below

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Medicare Card Details

Please provide your medicare card details below

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Based on your answers provided you are not eligible

Dr Franks requirements for acceptance onto the weight loss program are:

18 and over
BMI plus 25 if an ethnic minority
BMI plus 27 with obesity related health issues such as diabetes or high blood pressure
BMI plus 30 with no obesity related diseases

If you believe based on the above information you are eligible for the program, please resubmit your answers or book a consultation with one of our nurses

Resubmit Book a Consultation

Please provide us with your name?

What is your mobile number?

What is your email address?

What ethnicity are you?

What sex were you assigned at birth?

Are you currently pregnant, trying to get pregnant, or breastfeeding?

What is your Date of Birth?

What is your height & weight?

Have you been diagnosed with diabetes?

Do you suffer from any of the following?

Please list any other medical conditions you have.

Do any of the following statements apply to you?

Please tell us more about your specific diagnosis and how you manage it

Have you ever taken any of the following medications to help you lose weight?

Have you EVER taken a GLP-1 injectable?

Are you presently taking this medication?

Can you tell us how long you have been taking this medication and share your experience with it?

Please indicate whether you are presently using any medication, such as prescription drugs, over-the-counter medications, or supplements, by selecting all that are applicable to you.

Please list all prescription medication that you currently take

How did you respond to the medication, and what led you to discontinue its use?

Have you taken Ozempic, Wegovy, Rybelsus, Saxenda medication in the past 28 days?

As you have taken Ozempic, Rybelsus or Saxendamedication in the past 28 days, please provide a photo of your medication.

Do you have any known allergies? If yes, please list them clearly in the space provided below. If you do not have any allergies, simply state 'none'

Share with GP

Share with GP

Medicare Card Details

Based on your answers provided you are not eligible

Do you agree and consent to the following?

Please provide us with your name?

What is your mobile number?

What is your email address?

What ethnicity are you?

What sex were you assigned at birth?

Are you currently pregnant, trying to get pregnant, or breastfeeding?

What is your Date of Birth?

What is your height & weight?

Have you been diagnosed with diabetes?

Do you suffer from any of the following?

Please list any other medical conditions you have.

Do any of the following statements apply to you?

Please tell us more about your specific diagnosis and how you manage it

Have you ever taken any of the following medications to help you lose weight?

Have you EVER taken a GLP-1 injectable?

Are you presently taking this medication?

Can you tell us how long you have been taking this medication and share your experience with it?

Please indicate whether you are presently using any medication, such as prescription drugs, over-the-counter medications, or supplements, by selecting all that are applicable to you.

Please list all prescription medication that you currently take

How did you respond to the medication, and what led you to discontinue its use?

Have you taken Ozempic, Wegovy, Rybelsus, Saxenda medication in the past 28 days?

As you have taken Ozempic, Rybelsus or Saxendamedication in the past 28 days, please provide a photo of your medication.

Do you have any known allergies? If yes, please list them clearly in the space provided below. If you do not have any allergies, simply state 'none'

Share with GP

Share with GP

Medicare Card Details

Based on your answers provided you are not eligible