Hair Loss

Patient's personal details

Do you have any recent or past medical history of note? *

Add extra details if required. *

Do you take any current or repeat medicines? *

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Do you take any current or repeat medicines? Creams? Other topicals? *

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Have you had a serious reaction to any hair loss medicines before? *

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Current Health

Do you suffer from any scalp conditions (such as fungal infections)? *

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Have you had any rapid weight loss in the past 6 months? *

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What symptoms are you experiencing?

Is the progression of your hair loss symmetrical (the same on the right as on the left side of your scalp)? *

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Is the hair loss only located at the temples or the side of the forehead? Is there any associated redness or inflammation to the scalp? *

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Is your hair loss in clumps / patches? Is the hair loss rapid? *

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Further information about Finasteride 1mg... (Copy)

Do you understand that regrowth of hair can take up to 6 months and is most effective up to 2 years? *

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Do you understand that any hair growth may be lost 6-12 months after treatment? *

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GP notification...

Do you agree to tell your doctor or pharmacist about any side effects you may be experiencing with the medicines and any progression of symptoms? And have a comprehensive review in 2 years from the initial supply? *

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Finasteride 1mg like many other medicines can interact with other medicines you may take; in this respect we recommend that you notify your doctor. Do you agree? *

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Write below any further information which may be relevant e.g. medicines taking, conditions, concerns...

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£666.00

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Hair Loss

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