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Xenical - Click here
to order online


Xenical - Click here
to order offline

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   Tue September 07 2010




With this form you can purchase Xenical using your credit card.

The following information is needed by the doctor in order to safely prescribe Xenical.

Medical Questionnaire - Part 1 of 4

Date of Birth:

Click here to select from imperial measurements for height and weight

Height (m):
Weight (Kg):

Select Sex
Female Male

Do you suffer or have you ever suffered from Anorexia Nervosa, Binge Eating Disorder or Bulimia ?
No Yes

Do you suffer from any Malabsorption Syndrome (eg Chron's Disease, Idiopathic Steatorrhoea or Tropical Sprue)? No Yes

You should not breastfeed your infant during treatment with Xenical as it is not known whether Xenical is secreted in human milk.
Are you currently breastfeeding, or do you intend to be doing so in the near future?
No Yes

Do you take the medicine Cyclosporine (Neoral, Sandimmune, SangCya)? No Yes


Do you suffer from the medical condition Cholestasis or any disorder of the gallbladder? Answer "No" if you have had your gallbladder removed.
No Yes

Do you suffer from Hypothyroidism?
Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormone.
No Yes


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