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Medical Screening

Do you suffer from any of the following?

  • Severe Liver or kidney problems

  • Heart failure

  • History of Pancreatitis (Inflammation of the pancreas)

  • Multiple endocrine neoplasia type 2 (a rare hormone-related disorder)

  • A cancer that requires monitoring or treatment

  • Type 1 diabetes

  • Diabetes-related eye problems (such as diabetic retinopathy)

  • Personal or family history of thyroid cancer

  • A current eating disorder or a history of an eating disorder? (e.g., anorexia, bulimia, binge eating disorder)

  • A history of gallstones (if you still have your gallbladder)

  • Severe digestive conditions, including Ulcerative Colitis, Crohn’s Disease, or gastroparesis (delayed stomach emptying)

  • Glaucoma, epilepsy, or porphyria

Have you been diagnosed with any of these medical conditions?

 

  • Type 2 diabetes

  • High blood pressure

  • High cholesterol

  • Erectile dysfunction

  • Sleep apnoea

  • Asthma

  • Osteoarthritis

  • Chronic back pain

  • Depression

  • PCOS

  • Fatty liver disease

Are you currently pregnant?

Are you taking any of the following medications?

  • Insulin

  • Sulfonylureas e.g., gliclazide

  • Orlistat

Are you currently taking any prescription medication?

Do you agree and consent to the following?

  • I will be the sole user of the medication

  • I will read all relevant information before starting treatment

  • I will inform my doctor of any changes to my medical history

  • I will stop the medication if I fall pregnant or try to conceive, and I will let the my doctor know about these changes

  • I will contact the a medical professional if I miss two or more doses

  • I understand medication may be prescribed off-label when clinically appropriate

  • Acure's sale terms & conditions

An error occurred. Please check that you have answered all the questions correctly.

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