Please fill the following^*

Email^*

Company^*

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Product/Brand name^*

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Website URL^*

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One-line description of the product^*

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Product description^*

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Which medication options do you provide?

Mounjaro Injection

Orlistat

Wegovy Injection

Wegovy Pills

Saxenda

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Mounjaro Injection Pricing

1st Mounjaro Dosage - 2.5mg^*

2nd Mounjaro Dosage - 5mg^*

3rd Mounjaro Dosage - 7.5mg^*

4th Mounjaro Dosage - 10mg^*

5th Mounjaro Dosage - 12.5mg^*

6th Mounjaro Dosage - 15mg^*

Additional pricing information on Mounjaro Injection

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Wegovy Injection Pricing

1st Wegovy Injection Dosage - 0.25mg^*

2nd Wegovy Injection Dosage - 0.5mg^*

3rd Wegovy Injection Dosage - 1mg^*

4th Wegovy Injection Dosage - 1.7mg^*

5th Wegovy Injection Dosage - 2.4mg^*

6th Wegovy Injection Dosage - 7.2mg^*

Additional pricing information on Wegovy Injection

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Wegovy Pills Pricing

1st Wegovy Pills Dosage - 1.5mg^*

2nd Wegovy Pills Dosage - 4mg^*

3rd Wegovy Pills Dosage - 9mg^*

4th Wegovy Pills Dosage - 25mg^*

Additional pricing Information on Wegovy pills

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Orlistat Pills Pricing

Skip this section if you don't prescribe Orlistat 60mg

1st Orlistat Dosage - 60mg

Additional pricing information on Orlistat 60mg pills

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Saxenda Pills Pricing

Skip this section page if you don't prescribe Saxenda

1st Saxenda Dosage - 0.6mg

2nd Saxenda Dosage - 1.2mg

3rd Saxenda Dosage - 1.8mg

4th Saxenda Dosage - 2.4mg

5th Saxenda dosage - 3.0mg

Additional pricing information on Saxenda pills

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Health coaching^*

Yes

No

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Mobile/web application^*

Yes

No

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Blood tests^*

Yes

No

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Habit change^*

Yes

No

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Nutrition Plan^*

Yes

No

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Digital Scale^*

Yes

No

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Clinical support^*

From licensed medical doctors, nutritionists, pharmacists et.c.

Yes

No

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Community^*

In-app, WhatsApp, circle or social media.

Yes

No

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Gym membership^*

Yes

No

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Progress tracking^*

Yes

No

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Average length of treatment^*

< 6 Months

6 Months

12 Months

18 Months

24 Months

> 24 Months

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Compliance & Registrations

Select all that apply

CQC Registered

GPhC Registered

Legit Script

NHS Registered

UKAS-Accredited Labs

Other

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Do you share patient data with GP?^*

No

Yes

Only when requested

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Payment plan

What payment frequency options are available^*

Monthly

3 months

6 months

12 months

Do you offer free trial^*

Yes

No

Additional pricing information

Money back assurances or guarantees included

/

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NHS & Insurance

Do you support NHS referral or medical insurance?^*

Yes

No

Additional information about insurance partners

List the insurance partners separated with comma.e.g. AXA, BUPA, Vitality et.c

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Call to Action URL^*

Add an offer to your listing

Offers are discounts or marketing prompts for qualified leads.
ONLY qualified leads will see offers from HSMA.

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Social media information

Share links/handles (e.g., Instagram, X/Twitter, TikTok).

TikTok Handle

Instagram Handle

X/Twitter Handle

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Prescriber Details

Prescribing Pharmacy

GPhC Registration Number

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Product Logo^*

You can drag & drop or paste as well

Maximum file size: 10MB

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Upload product pictures (up to 4 files)^*

You can drag & drop or paste as well

Accepts .jpg, .jpeg, .png

Maximum file size: 10MB

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We've received your submission

Our team will review the submission and ___ will be onboarded on HSMA if everything checks out within 48 hours. If we need more details or clarifications, someone will reach out to you.

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Onboard more patients with HSMA

Mounjaro Injection Pricing

Wegovy Injection Pricing

Wegovy Pills Pricing

Orlistat Pills Pricing

Saxenda Pills Pricing

Payment plan

NHS & Insurance

Social media information

Prescriber Details

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