Medical Assessment

To help us supply you with the most suitable treatment, please complete this online consultation.

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About You

Are you male and aged between 18-65?

Yes

This treatment is not suitable for women, or those under 18 or over 65.

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Your Symptoms

Are you suffering from hair loss?

Yes

We are unable to supply you with treatment if you are not suffering from hair loss. Please consult your GP or doctor for more information.

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Could your hair loss be explained by any medication, dietary matter or illness?

Yes

If a lifestyle or health factor is causing your hair loss, we recommend speaking to your GP or doctor for further advice.

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Do you have a healthy scalp?

no inflammation on the scalp
no redness
no medical dressings

Yes

We are unable to supply you with treatment. Please consult your GP or doctor.

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Do you have hair loss in patches, or have an itchy or sore scalp?

Yes

This treatment is not suitable for you. We recommend contacting your GP or doctor for further advice.

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Do you have sudden unexplained hair loss or complete hair loss?

Yes

This treatment isn't suitable for this type of hair loss. We recommend you speak to your GP or doctor for further advice.

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Is your hair loss limited to the temple area?

Yes

We may still be able to offer you hair loss treatment, but with a limited medicine range.

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Your Health

Are you allergic/hypersensitive to minoxidil, finasteride/propecia, ethanol, propylene glycol or lactose?

Yes

This treatment is not suitable for you.

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Do you have a history of depression or any other mental illness?

Yes

We will still be able to offer you treatment, but with a limited product range.

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Have you ever been diagnosed with one of the following conditions:

Heart disease (including chest pain, angina, heart attack or any history of cardiovascular event)
High blood pressure
Pheochromocytoma (cancer of the adrenal glands)
Male breast cancer
Acute porphyria (a rare hereditary disease affecting haemoglobin)
Prostate problems (prostate enlargement, prostatitis, prostate cancer)

Yes

This treatment is not suitable for you.

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Your Medication

Are you currently taking any medication (over-the-counter or prescription) or any recreational drugs?

Yes

Are you taking any of the following medications?

Dithranol — used to treat psoriasis
Tretinoin — used to treat acne or other skin disorders
Corticosteroids — hydrocortisone or betamethasone dipropionate
Petrolatum — a common ingredient in hair wax and gel

Yes

We are unable to supply you with treatment. Please consult your GP or doctor for more information.

Please complete this question.

Agreement

Do you understand that if you are prescribed finasteride and your partner is (or may be) pregnant, they should not handle crushed or broken tablets, and that you should always wear a condom during sex?

Yes

We are unable to supply you with treatment unless you understand and agree to this point.

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Do you understand that if you are prescribed finasteride, you should inform your GP of this before undergoing a PSA blood test for your prostate?

Yes

We are unable to supply you with treatment unless you understand and agree to this point.

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Do you agree to the following?

You will read the patient information leaflet supplied with your medication
You will contact us and inform your GP of your medication if you experience any side effects of treatment, you start new medication and/or your medical conditions change during treatment
The treatment is solely for your own use
You have answered all the above questions accurately and truthfully
You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health
You understand that whilst decisions relating to your treatment are made jointly between you and the prescriber, the final decision to issue a prescription will always be with the prescriber

Yes

You must agree to this before continuing. If you need assistance contact our customer support.

Please complete this question.

Medical Assessment

To help us supply you with the most suitable treatment, please complete this online consultation.

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