Initial Consultation - The Drink Less Method

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This is for people who are new to the Drink Less Method. Please remember to login if you have already completed the consultation.

Agree Terms

It is important that you read and agree to the terms

Suitability Assesment

A quick check to see whether you are medically compatible with the Drink Less Method

Your Health Profile

Just a few more details about your medical history

Your Alcohol Consumption

Tell us about your relationship with alcohol

Motivation for Treatment

Tell us why you want to cut back

Your Contact Details

Have your photo ID ready

Step 1/6

Agree Terms

IMPORTANT: Please accept the terms before continuing

Step 2/6

Suitability Assesment

Are you suited to the Drink Less Method?

Step 3/6

Your Health Profile

Step 4/6

Your Alcohol Consumption

Step 5/6

Motivation for Treatment

Step 6/6

Your Contact Details

Have your ID ready for verification

Photo ID Required

Please have a valid photo ID ready to complete this consultation.

By proceeding, you confirm the following:

You understand that providing accurate and honest responses to this questionnaire is essential. Supplying false or incomplete information may put your health at serious risk and could lead to life‑threatening consequences.
You will disclose any medications you are currently taking.
You will disclose any medical conditions, serious illnesses, or past operations.
You are completing this consultation on your own behalf and to the best of your knowledge.
You consent to the use of unlicenced medications.
You agree to our Terms & Conditions and Terms of Sale, and confirm that you have read our Privacy Policy.

I agree

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Are you over 18 years old?

YesNo

You must be over 18 years of age to use this service. Please consult your doctor (GP) or visit a local pharmacy for help.

Are you currently taking regular opioid medications?

YesNo

This is particularly important for the use of opioid-receptor antagonists (including morphine and codeine.)

We are sorry, the Drink Less Method is not available to people taking opiod medicines. Please contact your G.P.

Are you currently pregnant or breastfeeding?

YesNo

We are sorry, the Drink Less Method is not available during pregnancy or breastfeeding. Please contact your G.P.

Do you currently suffer from any liver conditions?

YesNo

We are sorry, the Drink Less Method is not available for patients with ongoing liver conditions. Please contact your G.P.

Save

Good News: You appear to be suitable for the Drink Less Method.

We have a few more questions to help us to tailor your programme

Have you ever been diagnosed with any serious medical conditions?
e.g. heart failure, liver or kidney problems etc.

YesNo

Please provide details

Are you currently on any medication for any reasons?
This includes any prescribed, purchased or recreational medicines.

YesNo

Please provide details e.g. name of medicines, doses, forms, how often taken, any side effects, etc.

Have you got any known allergies?

YesNo

Please provide details

Do you have any mental health issues?

YesNo

Please provide details

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Your Drinking Patterns

What is your average weekly alcohol consumption? You can calculate the figure here
units consumed

Approximately how many days a week do you drink? days per week

Do you tend to binge drink at the weekends?

YesNo

Do you drink first thing in the morning?

YesNo

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What are your Goals with this treatment?

Reduce drinkingAbstinenceControl cravingsReduce harmImprove healthImprove relationshipsOther

Please tell us about your other motivation

How motivated are you to want to reduce drinking?

1 is 'not bothered' and 10 is 'fanatical'

12345678910

What do you feel contributes to your excessive drinking?

Peer pressureStressEmotional drinkingLack of will powerOther

What specifically contributes to your drinking

Would you like to tell us about anything else?

YesNo

Please let us know what's on your mind

Save

You appear suitable for the Drink Less Method.

Please enter your details to continue

Your email address First name Last name

Your Address

First Line of Address Town Postcode Mobile Phone Number Gender

MaleFemaleOther

Date of Birth* Your GP's Surgery Name (we will not contact the GP without your permission) Your NHS Number (optional - if Known) Any other remarks for our clinician? (optional) Please provide a photo of your valid ID (e.g. driving licence, passport) for verification.

We are required to verify customer/patient identity in accordance with UK law.
Your ID should be clear and legible.
Your privacy is important to us and your personal information will remain confidential.

We recommend that you advise your GP of this treatment so they can keep full track of your care.I Understand

Do you agree to the following?

You confirm that all details you have provided are accurate, truthful, and complete.
You will read the Patient Information Leaflet (PIL) included with your medicine and follow the guidance provided.
You consent to us verifying your age and identity before accessing our services.
You agree to be contacted by our clinicians whenever necessary.
You will use the medicine solely for the individual it was assigned to, and strictly for its intended purpose.
You will promptly inform us of any concerns or side effects related to products supplied by RemiVida.
You accept the RemiVida Terms & Conditions and Privacy Policy.

I Agree

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To save your progress you can enter your email address and we will send you a direct link back to your consultation

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Email * Please provide a valid email. Send Link

Thank you! The link has been sent to your email.