** PLEASE DESCRIBE THIS IMAGE **Meridia Weight Loss Pill Order Form
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As a doctor I am quite often asked what is the difference between Merida and Reductil? The confusion originates because the Meridia weight loss pills are marketed under the brand name Reductil in Europe and Meridia in the United States. However both Meridia and Reductil represent the exact same diet pill. Both Meridia and Reductil contain the same active ingredient sibutramine hydrochloride.

Compare the Two Trade Mark Logos For Meridia and Reductil

 Marked similarities between the two logos, same color codes, character font, and the most important fact same both Meridia and Reductil have the same active ingredient sibutramine HCL monohydrate.

** PLEASE DESCRIBE THIS IMAGE **Meridia, Reductil helps you to lose weight fast without feeling hungry. Meridia, Reductil represents one of the strongest weight loss pills (appetite suppressants) on the market.

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Medical History: Please read the following list of medical conditions carefully.
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Do you or any of your immediate family have a history of the following medical conditions?
Blood disorders e.g. anemia, hemophilia, hemochromatosis, phlebitis, sickle cell anemia, thalassemia, thrombosis, hypercholesterolemia, etc.
Cancer e.g. brain, breast, bladder, colorectal, endometrial, leukemia, lung, lymphoma, multiple myeloma, ovarian, prostate, skin, testicular, etc.
Cardiovascular disease e.g. angina, arrhythmia, atrial fibrillation, claudication, congestive heart failure, valve disorder, heart attacks, high blood pressure, strokes, etc.
Endocrine disorder e.g. diabetes, goiter, hyperthyroidism, hypothyroidism, pheochromocytoma, thyroiditis, etc.
Eye disorders e.g. cataracts, glaucoma, retinal complications, etc.
Gastrointestinal disorder e.g. acid reflux, hiatal hernia, irritable bowel syndrome (Crohn's disease, ulcerative colitis), polyps, rectal bleeding, ulcers, etc.
Genitourinary disorder e.g. benign prostatic hyperplasia, cysts, endometriosis, pelvic inflammatory disease, etc.
Immune disorders e.g. Hashimoto's disease, eczema, HIV, Graves disease, Sjogrens syndrome, sarcoidosis, sclerodoma, etc.
Kidney (urinary tract) disorder e.g. bladder disorders, cystic disease, glomerular disease, nephrotic syndrome, renal failure, urinary tract complications, etc.
Liver disorder e.g. cirrhosis, Gilbert's syndrome, hepatitis, hemochromatosis, Wilson's disease, etc.
Musculoskeletal e.g. arthritis, back/spine complications, fibromyalgia, gout, lyme disease, muscular dystrophy, myasthenia gravis, osteomalacia, osteoporosis, rickets, spinal cord injury, etc.
Neurological disorder e.g. Alzheimer's disease, epilepsy, head injuries, headaches, Huntington's disease, multiple sclerosis, seizure, etc.
Psychological disorder e.g. anxiety, attention deficit disorder, bipolar disorder, depression, obsessive compulsive disorder, panic disorder, post traumatic stress disorder, etc.
Respiratory disorder e.g. allergic rhinitis, asthma, chronic bronchitis, emphysema, tuberculosis etc.
Other e.g. acne, chemical dependency, menopause, nutritional disorder, obesity, pregnant/nursing, significant trauma, etc.
Do you have a history of any of the medical conditions previously mentioned including Blood disorders, Cancer, Cardiovascular disease, Endocrine disorder, Eye disorders, Gastrointestinal disorder, Genitourinary disorder Immune disorders, Kidney (urinary tract) disorder, Liver disorder Musculoskeletal, Neurological disorder, Psychological disorder, Respiratory disorder, Other conditions (not mentioned)?
 If yes, please explain. For example, duration of illness, any surgery or treatment (ten year history of hypertension (high blood pressure), Atenolol 50mg one per day - well controlled with medications, Blood pressure 132/84):		 Yes
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Currently, are you taking any medications (this includes over-the-counter or nonprescription medication, herbal supplements, sports supplements, etc.)
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Reductil Specific Questions:
Please read the following list of medical questions carefully. Be sure to give any explanations if your answer is "yes" to any of the following.
Currently, are you following any type of diet program or have you been on any diets in the past?
If yes, please explain:

 Yes
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Do you have a history of any eating disorders e.g. anorexia, bulimia, etc.?
If yes, please explain:
 Yes
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Do you have any history of cardiovascular complications (heart attack, congestive heart failure, unstable angina [chest pain], arrhythmia [an abnormal heartbeat rhythm] uncontrolled hypertension or hypotension, history of postural hypotension, stroke, transient ischemic attacks [TIAs], etc), epilepsy, kidney and/or liver disease, glaucoma, alcohol or drug addition, eating disorders (anorexia nervosa, bulimia, etc.), pulmonary hypertension, pheochromocytoma, Tourettes syndrome, seizures, gall stones, etc.?
If yes, please explain:
Yes
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Do you have any organic causes of obesity including hypothyroidism?
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Are you taking any, dietary supplements, laxatives, steroids, prescription medications including: weight loss medications (diethylpropion, phentermine, phendimetrazine, ephedra [ma huang], yohimbe. etc.), medications that can raise blood pressure such as decongestants (pseudoephedrine, phenylpropanolamine etc.), cough suppressants (dextromethorphan, pseudo ephedrine, etc.), MAO Inhibitors (Marplan [isocarboxazid], Nardil [phenelzine sulfate], Parnate [tranylcypromine], Eldepryl [selegiline hcl] Manerix ]moclobemide], etc.), tricyclic antidepressants Elavil [amitrypfiline], Lofepramine [methotrimeprazine], etc.), Selective Serotonin Re-uptake Inhibitors (SSRls) (Prozac [fluoxetine], Zoloft [sertraline], Effexor [venlafaxine hcl], Luvox [fluvoxamine maleate], Paxil [paroxetine hcl]), Zyban [bupropion hcl], Serzone [nefazodone],etc.), bipolar medication (Lithium Carb [lithium], etc.), epilepsy medications (Carbamazepine [carbamazepine]), Phenob [phenobarbital], Dilantin [phenytoin], etc.) Parkinson's disease (Larodopa [levodopa], Lodosyn [carbidopa],etc.), pain medications (Sublimaze [fentanyl], Elmiron [pentazocine], Touro DM [dextromethorphan], Demerol [meperidine], etc.), steroids (Gengraf [cyclosporin], Aeroseb-DEX [dexamethasone],etc.), anti fungal medication (Nizoral [ketoconazole]), antibiotics (ERY-Tab [erythromycin], Rifadin [rifampicin], Biaxin [clarithromycin], Nizoral (ketoconazole],etc.); migraine medications (Imitrex [sumatriptan], Migranal [dihydroergotamine]); antiinfectives (Furoxone [furazolidone], etc.)
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Yes
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Are you pregnant, breast-feeding or planning to conceive?
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** PLEASE DESCRIBE THIS IMAGE **

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