Your Health
The information you provide us is treated with absolute confidentiality and will be reviewed by our experienced UK prescribers. We ask the following questions to provide the prescriber with an appropriate level of information to make an informed decision on whether the treatment is suitable or not.
What is your gender?
Please provide more detail.
Do you need help completing this questionnaire?
Please contact us on 020 7157 9759 or email [email protected] and we can assist you.
Do you believe that you have the capacity to make decisions about your own healthcare?
Sorry we can't offer you this treatment, please contact your GP.
Have you been diagnosed with any medical conditions?
Are you currently taking any medication? This includes prescription-only, over-the-counter and homeopathic medicines.
Do you suffer from any allergies?
Please provide details including which allergies and what symptoms you experience.
Is there anything else you would like to include to allow our prescriber to prescribe responsibly?
Medical Questions
Are you a male and aged between 18-65 years old?
Please provide more details
Are you suffering from hair loss?
Do you have hair loss in patches, or have an itchy or sore scalp?
Is you hair loss limited to the temple area?
Please be aware that there is no clinical evidence supporting this medicine’s use in treatment of hair loss only in the temple area.
Are you experiencing any scalp inflammation?
Do you have sudden unexplained hair loss or complete hair loss?
Could your hair loss be explained by any medication or illness (i.e chemotherapy or dietary)?
Are you allergic (hypersensitive) to Propecia or Finasteride?
Are you currently taking Finasteride for any condition other than hair loss?
Do you understand that:
Do you understand that Finasteride may take up to 6 months before symptoms start to improve?
Have you ever been diagnosed with prostate disease or male breast cancer?
Please upload a photo of your hair loss to allow us to make an appropriate prescribing decision.
*This is not compulsory, but will help avoid delays with your order.*
Do you agree to the following?
Consent
Would you like us to notify your GP of the treatment you chose to order today?
Please provide details.
It is very important that your GP is aware of all the medication you are taking, so that you are receiving the best possible care. You should only select “no” if you are completely sure you do not wish us to tell your GP.
Do you agree to the following:
If treatment is not suitable, you will be fully refunded and signposted to another point of care. The decision about the treatment is for both the patient and the prescriber to consider, however, the final decision will always lie with the prescriber.
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