Debugging Form Data:

Array
(
    [0] => Array
        (
            [field_name] => Category_ID
            [field_value] => 100
        )

    [1] => Array
        (
            [field_name] => Current_UserName
            [field_value] => Christopher Elliott
        )

    [2] => Array
        (
            [field_name] => Page_Id
            [field_value] => 290
        )

    [3] => Array
        (
            [field_name] => session_id
            [field_value] => 82d80ee456f8446a32742d71703b6bfb
        )

    [4] => Array
        (
            [field_name] => first_name_
            [field_value] => Christopher
        )

    [5] => Array
        (
            [field_name] => surname_
            [field_value] => Elliott
        )

    [6] => Array
        (
            [field_name] => date
            [field_value] => 10/07/1986
        )

    [7] => Array
        (
            [field_name] => do_you_confirm_you_are_over_18_years_old
            [field_value] => Yes, I confirm
        )

    [8] => Array
        (
            [field_name] => gender_
            [field_value] => Male
        )

    [9] => Array
        (
            [field_name] => pregnant_breast
            [field_value] => 
        )

    [10] => Array
        (
            [field_name] => gender_other
            [field_value] => 
        )

    [11] => Array
        (
            [field_name] => email_address
            [field_value] => chrise1986@hotmail.co.uk
        )

    [12] => Array
        (
            [field_name] => contact_number
            [field_value] => 07496854875
        )

    [13] => Array
        (
            [field_name] => weight_kg
            [field_value] => 86.163
        )

    [14] => Array
        (
            [field_name] => height_cm
            [field_value] => 172.72
        )

    [15] => Array
        (
            [field_name] => do_you_have_the_capacity_to_make_your_own_decisions_about_your_healthcare
            [field_value] => Yes
        )

    [16] => Array
        (
            [field_name] => capacity_to_make_decisions
            [field_value] => 
        )

    [17] => Array
        (
            [field_name] => do_you_have_any_medical_conditions_that_have_been_diagnosed_by_your_gpother_healthcare_professional
            [field_value] => No
        )

    [18] => Array
        (
            [field_name] => medical_diagnosis
            [field_value] => 
        )

    [19] => Array
        (
            [field_name] => are_you_on_any_medication_including_prescription_medicines_and_or_over_the_counter_medicines
            [field_value] => No
        )

    [20] => Array
        (
            [field_name] => medical_information
            [field_value] => 
        )

    [21] => Array
        (
            [field_name] => do_you_suffer_from_any_allergies_
            [field_value] => No
        )

    [22] => Array
        (
            [field_name] => allergies
            [field_value] => 
        )

    [23] => Array
        (
            [field_name] => are_you_a_smoker_includes_cigarettesrolliescigar_and_vapes
            [field_value] => Yes
        )

    [24] => Array
        (
            [field_name] => smoker_status
            [field_value] => Vaping
        )

    [25] => Array
        (
            [field_name] => do_you_drink_alcohol
            [field_value] => Yes
        )

    [26] => Array
        (
            [field_name] => alcohol_status
            [field_value] => 3 to 4 not every week
        )

    [27] => Array
        (
            [field_name] => pregnant_yes
            [field_value] => 
        )

    [28] => Array
        (
            [field_name] => please_enter_your_up_to_date_weight_in_kg:
            [field_value] => 86.163
        )

    [29] => Array
        (
            [field_name] => what_is_your_target_weight_in_kg
            [field_value] => 77.564
        )

    [30] => Array
        (
            [field_name] => have_you_previously_tried_to_lose_weight_by_diet_and_exercise_alone
            [field_value] => Yes
        )

    [31] => Array
        (
            [field_name] => are_you_currently_on_any_weight_loss_treatment
            [field_value] => No
        )

    [32] => Array
        (
            [field_name] => other_provider
            [field_value] => 
        )

    [33] => Array
        (
            [field_name] => other_treatment_
            [field_value] => 
        )

    [34] => Array
        (
            [field_name] => please_provide_us_with_proof_of_treatment_you_have_received_if_it_is_not_from_us_ensure_proof_clearly_shows_your_full_name_the_date_of_supply_drug_name_strength_and_quantity__failure_to_provide_this_proof_will_delay_your_order
            [field_value] => 
        )

    [35] => Array
        (
            [field_name] => injecting_problems
            [field_value] => 
        )

    [36] => Array
        (
            [field_name] => side_effects
            [field_value] => 
        )

    [37] => Array
        (
            [field_name] => what_was_your_weight_in_kg_before_starting_any_weight_loss_treatment
            [field_value] => 
        )

    [38] => Array
        (
            [field_name] => how_much_weight_have_you_lost_in_kg_since_your_last_order
            [field_value] => 
        )

    [39] => Array
        (
            [field_name] => how_much_weight_have_you_lost_in_kg_since_you_first_started_treatment
            [field_value] => 
        )

    [40] => Array
        (
            [field_name] => have_you_made_any_lifestyle_changes_to_support_your_weight_loss_journey_for_example_have_you_increased_your_physical_activity_or_adjusted_your_diet_please_provide_as_much_detail_as_possible
            [field_value] => 
        )

    [41] => Array
        (
            [field_name] => break_in_treatment
            [field_value] => 
        )

    [42] => Array
        (
            [field_name] => are_you_requesting_more_than_one_pen_today
            [field_value] => No
        )

    [43] => Array
        (
            [field_name] => number_of_pens
            [field_value] => 
        )

    [44] => Array
        (
            [field_name] => what_is_the_circumfrrence_of_your_waist_in_cm
            [field_value] => 86.36
        )

    [45] => Array
        (
            [field_name] => have_you_suffered_from_any_eating_disorders
            [field_value] => No
        )

    [46] => Array
        (
            [field_name] => eating_disorders
            [field_value] => 
        )

    [47] => Array
        (
            [field_name] => does_food_or_body_image_affect_you
            [field_value] => Yes
        )

    [48] => Array
        (
            [field_name] => body_image
            [field_value] => I have lost confidence
        )

    [49] => Array
        (
            [field_name] => do_you_suffer_from_any_of_the_following_conditions_please_select_all_that_apply:_
            [field_value] => Array
                (
                    [0] => None of the above 
                )

        )

    [50] => Array
        (
            [field_name] => what_is_your_blood_pressure
            [field_value] => Normal (90/60 mmHg to 140/90 mmHg)
        )

    [51] => Array
        (
            [field_name] => are_you_currently_taking_any_of_the_following_medications_please_select_all_that_apply:_
            [field_value] => Array
                (
                    [0] => None of the above 
                )

        )

    [52] => Array
        (
            [field_name] => other_medication
            [field_value] => 
        )

    [53] => Array
        (
            [field_name] => please_confirm_how_many_calories_you_have_on_a_daily_basis
            [field_value] => 2,000 to 2,500 calories a day
        )

    [54] => Array
        (
            [field_name] => please_let_us_know_what_you_typically_eat_in_a_day_for_each_meal__and_snacks_
            [field_value] => Chicken mayo sandwich protein yoghurt protein drink and dinner meat or fish with cards and veg
        )

    [55] => Array
        (
            [field_name] => what_do_you_do_for_a_living_and_how_active_is_your_job
            [field_value] => Nhs theatre assistant
        )

    [56] => Array
        (
            [field_name] => how_much_exercise_do_you_do_each_week
            [field_value] => 1-2 hour
        )

    [57] => Array
        (
            [field_name] => which_medication_are_you_requesting_today
            [field_value] => Mounjaro
        )

    [58] => Array
        (
            [field_name] => do_you_suffer_from_any_of_the_following__please_select_all_that_apply:_
            [field_value] => Array
                (
                    [0] => None 
                )

        )

    [59] => Array
        (
            [field_name] => do_you_need_a_sharps_bin_for_disposal_of_used_needles
            [field_value] => Yes
        )

    [60] => Array
        (
            [field_name] => do_you_require_a_call_with_the_pharmacist_regarding_your_order
            [field_value] => No
        )

    [61] => Array
        (
            [field_name] => do_you_confirm_that_you_are_aware_that_this_treatment_should_be_taken_in_conjunction_with_a_well_balanced_calorie_controllednutritional_diet_no_more_than_30_of_your_calories_should_come_from_fat_and_your_diet_should_generally_be_rich_in_fruit_and_vegetables
            [field_value] => Yes, I confirm
        )

    [62] => Array
        (
            [field_name] => do_you_confirm_that_you_will_ensure_to_keep_good_levels_of_hydration_by_drinking_8-11_cups_of_liquid_per_day_27l
            [field_value] => Yes, I confirm
        )

    [63] => Array
        (
            [field_name] => do_you_confirm_you_understand_you_should_contact_your_own_gp_and_24_hr_pharmacy_if_you_have_not_managed_to_achieve_a_5_loss_of_your_body_weight_within_a_12_week_period_and_you_agree_to_have_a_review_with_your_gp_or_24_hr_pharmacy_after_taking_this_medication_for_12_weeks_to_ensure_the_medication_is_still_suitable_and_if_further_treatment_is_required
            [field_value] => Yes, I confirm
        )

    [64] => Array
        (
            [field_name] => do_you_confirm_that_you_will_follow_the_injecting_guidelines_which_are_available_on_our_website
            [field_value] => Yes, I confirm
        )

    [65] => Array
        (
            [field_name] => do_you_agree_that_you_will_keep_the_pen_in_a_refrigerator_between_2°c_to_8°c_once_you_receive_your_delivery_if_you_do_not_do_this 24hr_pharmacy_cannot_and_will_not_be_held_responsible_for_the_medication_not_functioning_as_intended_once_you_start_using_the_pen_you_can_keep_the_pen_for_1_month_when_stored_at_a_temperature_below_30°c_please_note_this_medication_can_only_be_delivered_using_the_next_day_delivery_by_1pm_courier_service
            [field_value] => Yes, I agree
        )

    [66] => Array
        (
            [field_name] => do_you_confirm_that_if_you_have_not_ever_had_any_weight_loss_medication_you_are_required_to_start_on_the_lowest_strength__choosing_a_higher_strength_will_result_in_an_automatic_rejection_of_your_order_a_higher_strength_can_only_be_selected__if_you_have_ongoing_treatment_from_us_or_elsewhere_providing_there_is_evidence_of_treatment
            [field_value] => Yes, I confirm
        )

    [67] => Array
        (
            [field_name] => do_you_accept_that_all_orders_placed_for_weight_loss_medication_from_friday_3pm_onwards_saturday_and_sunday_will_be_shipped_out_on_monday_due_to_the_items_being_temperature_controlled_please_ensure_you_are_able_to_receive_your_delivery_as_24_hr_pharmacy_will_not_be_liable_for_any_missed_deliveries
            [field_value] => Yes, I confirm
        )

    [68] => Array
        (
            [field_name] => in_order_to_provide_safe_and_effective_treatment_you_are_required_to_provide_consent_for_us_to_inform_your_gp_of_treatment_you_are_receiving_from_us
            [field_value] => Yes, I consent
        )

    [69] => Array
        (
            [field_name] => gp_surgery_name
            [field_value] => Riverview medical centre
        )

    [70] => Array
        (
            [field_name] => gp_name
            [field_value] => Dr lang
        )

    [71] => Array
        (
            [field_name] => surgery_address
            [field_value] => 6-8 george street
        )

    [72] => Array
        (
            [field_name] => surgery_contact_number
            [field_value] => 01505 320208
        )

    [73] => Array
        (
            [field_name] => surgery_email_address
            [field_value] => 
        )

    [74] => Array
        (
            [field_name] => do_you_confirm_you_will_read_the_patient_information_leaflet_on_how_to_use_this_medication_its_side_effects_and_warnings
            [field_value] => Yes, I confirm
        )

    [75] => Array
        (
            [field_name] => do_you_confirm_this_medication_is_for_your_personal_use_only
            [field_value] => Yes, I confirm
        )

    [76] => Array
        (
            [field_name] => do_you_confirm_you_have_completed_the_consultation_form_truthfully_and_accurately_in_order_for_us_to_make_a_suitable_supply_you_understand_that_giving_false_information_or_withholding_information_could_be_unsafe_and_detrimental_to_your_health
            [field_value] => Yes, I confirm
        )

    [77] => Array
        (
            [field_name] => do_you_confirm_you_agree_to_our_terms_and_conditions_privacy_policy_and_our_refund_policy
            [field_value] => Yes, I confirm
        )

    [78] => Array
        (
            [field_name] => do_you_understand_that_the_images_of_medicine_on_our_website_are_for_illustration_purposes_only_
            [field_value] => Yes, I confirm
        )

    [79] => Array
        (
            [field_name] => do_you_confirm_that_you_understand_at_this_stage_your_order_isn’t_confirmed_it_needs_to_be_reviewed_by_our_medical_team_before_it_is_approved_and_the_final_decision_lies_with_our_medical_practitioners_if_for_any_reason_your_order_is_rejected_you_will_be_given_advice_signposted_and_a_full_refund_will_be_issued
            [field_value] => Yes, I confirm
        )

    [80] => Array
        (
            [field_name] => please_upload_a_clear_full-length_photo_of_yourself_fully_clothed_including_your_face_while_holding_a_piece_of_paper_with_the_current_date_written_on_it
            [field_value] => https://24hrpharmacy.co.uk/wp-content/uploads/2025/07/nex_forms_file_688145b23c897.jpg
        )

    [81] => Array
        (
            [field_name] => please_upload_a_clear_photo_of_your_valid_photo_id_eg_passport_or_driving_licence_
            [field_value] => https://24hrpharmacy.co.uk/wp-content/uploads/2025/07/nex_forms_file_688145b23ddd4.jpg
        )

)

Category ID