Question 1 of 12
What hair loss treatment have you tried in the past?
Question 2 of 12
Did you have any side effects from previous hair loss medicine that would prevent you using them again?
Question 3 of 12
When did you first notice hair loss?
Question 4 of 12
Was the hair loss gradual or sudden?
Question 5 of 12
Do you have a family history of hair loss?
Question 6 of 12
Do you have any of the following medical conditions:
Question 7 of 12
Have you had any of the following symptoms?
Question 8 of 12
Certain medical conditions make it unsafe to take Finasteride. Please select all that apply to you:
Question 9 of 12
Are you currently taking any medications or supplements? If so, please provide information below.
Question 10 of 12
Do you have any drug allergies?
Question 11 of 12
Is there any further information you would like to include?
Question 12 of 12
Would you like to have a video or telephone consultation?