Saxenda Medical History & Consent Form - CC Kat Aesthetics 2025

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The document is a Saxenda Medical History & Consent Form used for patients seeking treatment with Saxenda (Liraglutide) for weight management. It collects personal and medical information, including patient history, current medications, and consent for treatment. The form outlines the benefits, risks, and necessary lifestyle changes associated with Saxenda treatment, as well as the importance of ongoing communication with healthcare providers. Patients must acknowledge understanding of the treatment protocol, potential side effects, and their rights regarding consent.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your consultation date and time at the top of the form. This helps establish a timeline for your treatment.
Fill in your personal details, including date of birth, first name, last name, gender, occupation, and contact information. Ensure accuracy for effective communication.
Complete the emergency contact section with relevant details. This is crucial for safety during treatment.
Provide information about your GP or consultant, including their name and contact details. This allows for coordinated care.
Indicate whether you give permission to inform your GP about the Saxenda treatment by circling 'yes' or 'no'.
Answer the medical history questions thoroughly. Be honest about previous weight loss methods and any medical conditions.
Review all sections carefully before signing and dating the form at the end to confirm your consent.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is Saxenda the same as Ozempic?

Is Saxenda the same as Ozempic? No, Saxenda and Ozempic are 2 different medications that have different active ingredients, although they do belong to the same family of medications. Saxenda is approved for weight loss, while Ozempic is given to manage type 2 diabetes.

What does Saxenda do to the body?

How does Saxenda work? Saxenda (liraglutide) aids weight loss by helping you feel fuller, reducing hunger levels and cravings, resulting in improved control of eating habits. Its active ingredient is liraglutide, which is a synthetic version of the naturally occurring hormone Glucagon-Like Peptide 1 (GLP-1).

What is the drug Saxenda used for?

Saxenda (liraglutide) injection 3 mg is an injectable prescription medicine used for adults with obesity or overweight (excess weight) who also have weight-related medical problems, and children aged 12-17 years with a body weight above 132 pounds (60 kg) and obesity to help them lose weight and keep the weight off.

Is Saxenda good for losing weight?

On average, people using Saxenda lose 3% to 8% of their starting body weight over 1 year, depending on their health history and age. Some people lose over 10% of their body weight during this time. During clinical studies: Adults without Type 2 diabetes: People receiving Saxenda lost about 8% of their body weight.

Does Saxenda cause skin rash?

Call your doctor right away if you have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth after using this medicine. This medicine does not cause hypoglycemia (low blood sugar).