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This consultation helps our clinical team determine whether hair-loss treatment is safe and appropriate for you. Please answer all questions honestly.

Birthday
Day
Month
Year
Please confirm that you live in the UK (excluding Channel Islands).
What is your sex at birth ?
Are you pregnant, breastfeeding or likely to conceive?

You can’t use some of our prescription treatments if you're pregnant or breastfeeding or likely to get pregnant. Get in touch if you become pregnant while on any of the treatments .

please confirm you have read and understand and would like to continue .
Do any of the following apply to you?
Have you experienced any of the following in the last 6 months?
Do you have any medical conditions such as :
Are you taking any of the following prescription medications?

if other please list below

What are your hair goals ?
How often do you wash your hair ?
How do you normally style your hair ?
Have you been diagnosed with any type of hair loss condition ?
Has the hair loss been gradual or sudden ?
When did you first notice hair loss ?
Do any close family members have hair loss?
Do you have any scalp symptoms?
Which areas are affected ?
Is the hair loss getting worse, stable or improving ?
Do you experience excessive hair shedding ?
Have you used any hair loss treatments before (e.g minoxidil or Finasteride0?
Do you have any known allergies to the following?
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This consultation will be reviewed by a qualified prescriber before any treatment is issued. we will respond within the next 24hrs

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