Consultation - Mentor Pharmacy

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1 Treatment Reorder Form

To ensure your treatment remains safe and effective, please complete this short check-in before reordering. It helps our clinicians understand your progress and provide the best support.

Are you experiencing any side effects since your last dose?

What is your current weight?

Weight

lbs

Stone

Pounds

How happy are you with your progress?

Very happy

I can tolerate it

Not happy

How often have you missed a dose?

Never

1–2 times

More than 3

Any changes to your diet or exercise?

Are you taking any new medicine or supplements?

Do you have any new or existing medical conditions we should be aware of?

Please upload a mirror selfie or progress pic

This needs to be an image of you standing in front of the mirror that shows your full body.

Only images are accepted.

Image #1

Would you like a follow-up consultation?

Yes

Is there anything we can do to improve your experience or support you better?

1 Treatment Reorder Form

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Acne

Asthma

Contraceptives

Eczema and Dermatitis

Erectile Dysfunction

Hay Fever

Menopause

Shingles

Urinary Tract Infection (UTI)

Ear Wax Removal

Private Blood Tests

Assessment for Test Condition 2

1 Treatment Reorder Form

Are you experiencing any side effects since your last dose?

Please provide more information

What is your current weight?

How happy are you with your progress?

How often have you missed a dose?

Any changes to your diet or exercise?

If so, please describe below

Are you taking any new medicine or supplements?

Please let us know below

Do you have any new or existing medical conditions we should be aware of?

Please explain below

Please upload a mirror selfie or progress pic

Would you like a follow-up consultation?

Is there anything we can do to improve your experience or support you better?

Assessment Progress

Quick Links

Acne

Asthma

Contraceptives

Eczema and Dermatitis

Erectile Dysfunction

Hay Fever

Menopause

Shingles

Urinary Tract Infection (UTI)

Ear Wax Removal

Private Blood Tests

Assessment for Test Condition 2

1 Treatment Reorder Form

Are you experiencing any side effects since your last dose?

Please provide more information

What is your current weight?

How happy are you with your progress?

How often have you missed a dose?

Any changes to your diet or exercise?

If so, please describe below

Are you taking any new medicine or supplements?

Please let us know below

Do you have any new or existing medical conditions we should be aware of?

Please explain below

Please upload a mirror selfie or progress pic

Would you like a follow-up consultation?

Is there anything we can do to improve your experience or support you better?

Assessment Progress

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