Weight Loss Management Service
Patient Acknowledgements
It is important that you read the following statements before your appointment with the community pharmacist.
If the pharmacist decides that you are clinically eligible to start the Monjouro (Tirzepatide), you will only be able to start treatment once you have agreed to the following statements.
If you agree to the following statements, please wait to be informed of your community pharmacist appointment by our administrative team.
If you disagree to any of the following statements, please contact us on 01430 440957 or email yhp.weightlossmanagement@nhs.net to be discharged from this service.
Statement 1) You understand that rapid weight loss and injectable weight loss treatments like Mounjaro can raise the risk of pancreatitis and gallbladder issues. If you have severe abdominal pain, vomiting, jaundice (yellowing of the skin), or worsening symptoms, you will seek urgent medical help.
Statement 2) You understand that severe diarrhoea for over 24 hours or vomiting within 3 hours of taking the contraceptive pill, can reduce its effectiveness. If this happens, you will call your GP or 111 for advice.
Statement 3) You understand that Mounjaro may reduce the effectiveness of the oral contraceptive pill. This means that you’ll need to use other forms of contraception (such as condoms or an IUD/implant) while taking Mounjaro to prevent unplanned pregnancy.
Statement 4) You understand that injectable weight loss treatments like Mounjaro should not be combined with other weight loss medications.
Statement 5) You recognise that these treatments may affect your mood. If you experience low mood or any mental health issues, you will stop the treatment and consult a doctor immediately.
Statement 6) As part of the community-based weight management service, this programme involves 9 months of ‘wrap-around care’ which offers advice and support on lifestyle, diet and exercise to enable you to lose weight healthily. You agree to participate in this wrap around care.
Statement 7) Your first appointment must be face-to-face. You agree to provide identification at this appointment.
Statement 8) We currently have clinics available in several locations across Humber and North Yorkshire - You are willing to travel to your first appointment.
Statement 9) You agree that the treatment is solely for your own use and understand that you cannot supply your prescribed medication to anyone else.
Statement 10) You agree to read the patient information leaflet supplied with the medication.
Statement 11) You will contact the prescriber and inform your GP if you experience any side effects from treatment, begin any new medication, or if your medical conditions change during treatment.
Statement 12) You agree to notifying your GP that you are taking GLP-1 weight loss medication and to allow your GP to share information with this service if they have any concerns.
Statement 13) You give your permission for the service to request further medical information from your GP if necessary.
Statement 14) The information you have provided to us is true and accurate to the best of your knowledge. The information you have provided will be used by the prescribers to decide whether it is appropriate to supply medication. You understand that failure to give accurate information may result in a refusal to supply medication, or the supply of medication that is not suitable.