Hair Loss


Before we are able to prescribe any medication to treat your Hair Loss , we are going to ask you some questions to ensure it is safe and appropriate for us to issue a prescription. The answers to these questions are reviewed by a prescribing clinician who will then authorise the treatment. Before proceeding to these questions, please tick the boxes below to consent the following:

  • You were assigned male at birth and are currently over 18 years of age

  • You are experiencing some form of Hair Loss

  • The treatment prescribed will only be taken by yourself

  • You will alert us to any serious conditions you may have and/or any procedures performed on yourself

  • You will alert us to any prescription medication you are taking

  • You will only use one Hair Loss treatment at a time

  • You are aware that the medication prescribed for Hair Loss may alter your mood, if this should happen you will seek advice from your GP

  • You will stop the treatment if you are considering to become a father

  • You agree to our terms and conditions

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How old are you?
When did you start to notice your hair loss?
Did the hair loss happen gradually or suddenly?
Is the hair loss localised to the head
Do you have any allergies to Finasteride?
Have you ever taken medication for your hair loss?
Do you currently have any problems with your scalp?
(Select all that apply)
Please let us know if any of the following are true?
Is there anything else you feel we should know in order to ensure it is safe for us to prescribe our treatments?
For example other health conditions, medication that you are taking, procedures you have had.
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Full Name
Date of Birth
Email Address
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