Transatlanticmeds

1. Enter your name

2. What is your biological sex?

3. Enter Mobile:

4. Enter Email:

5. Address

6. What is your date of birth?

7. Dosage of medication

8. Reason for requiring medication

9. Name of the prescribing doctor?

10. Have you used this medication before?

11. Are you taking any other medication?

12. Do you suffer from any other conditions?

13. Are you allergic to any substances, any medicine or food products?

14. What is your height? (in cm)

15. What is your weight? (in kg)

16. BMI

17. Upload original RX (jpg, png, pdf file supported)

18. Do you have Type 1 diabetes mellitus?

19. Do you have any history of medullary thyroid cancer?

20. Do you have history or family history of endocrine neoplasia?

21. Do you have any history of pancreatitis?

22. Do you have any liver or kidney impairment?

23. Do you have any history of gastrointestinal illness such as gateoparesis or malabsorption?

24. Are you pregnant or breastfeeding?

25. Do you have any history of diabetic retinopathy (diabetes eye disease involving retina)?

0.25mg $366.00

0.50mg $366.00

1mg $366.00

Submitted Data