Before proceeding to the Medical Consult Form please read     CONTRAINDICATIONS and accept the Waiver of Liability
	In order for MediTRIMTM  physicians to provide you the best care you need to reply honestly to all questions and you need to understand the health risks of being overweight vs the risks associated with Xenical.
	Contraindications: Anyone with the following conditions should not take Xenical Provided here is a list of medical conditions that are contraindications to taking Xenical.  Please complete this form first to proceed with the consultation.  Although there are no studies with Xenical showing adverse effects, pregnant women, nursing women and children under 18 are NOT advised to take Xenical at this time.
	History of hyperoxaluric or calcium oxalate kidney stones. Anyone currently taking the medication, cyclosporin. Xenical is contraindicated in anyone with intestinal malabsorption syndromes such  as Celiac disease, Chron's disease, ulcerative colitis, or bowel intestinal diseases. Xenical is contraindicated in anyone with cholestasis, gall bladder disease (If you have had your gall bladder removed it is OK to take Xenical. Pregnancy and nursing mothers:  Xenical should NOT be taken by pregnant or nursing mothers because there is not sufficient studies of Xenical in pregnant or nursing mothers. Pediatric patients under age 18 should not take Xenical because there are not sufficient studies. Patients currently suffering from active anorexia or bulimia should not take Xenical or any weight-loss medication without direct physical visits to their primary physician and constant monitoring.
	I   DO NOT HAVE ANY OF THE ABOVE CONTRAINDICATIONS: By accepting "I Agree" means than you have read the above contraindications and honestly acknowledge that you do not have any of the above contraindications to Xenical therapy: