Consultation

Question 1 of 10

Welcome to your private online men's clinic where you will be asked to answer some questions about your health to help us make an informed decision that the medication you are requesting is right for you.

Please confirm the following is true and accurate before continuing with this health consultation?

You were assigned male at birth
Your hair loss cannot be explained by medication or an illness (dietary, autoimmune disorder, chemotherapy)
Your hair loss has been gradual over the last few months or years
You are not experiencing any redness, pain, inflammation, flaking, swelling, scarring, or other damage to the scalp
Your hair loss pattern is limited to your temple areas and/or crown and is not patchy in a random pattern all over your scalp
You are not currently trying to have a baby and will not try to have a baby for the duration of this treatment

Untitled(Required)

I confirm

Please confirm the name of the medication and if it was successful(Required)

Regaine

Minoxidil

Propecia

Finasteride

Other

Please confirm the name of the medication and if it was successful(Required)

Are you allergic to any medications?(Required)

Yes

Please provide details about your allergy(Required)

Please provide the name of this medication as well as the type of reaction or allergy you hay have had

Are you currently taking any medication?(Required)

This will include prescription medication, over-the-counter and homoeopathic remedies or supplements.

Yes

Please provide more information about the medication you take(Required)

Please give the name, strength and instructions of how often you are taking your medication.

Have you been diagnosed with any medical or mental health conditions?(Required)

Yes

Please provide details about any previous medical or mental health conditions.(Required)

Please make sure to include details such as diagnosis, symptoms and treatment

Is there any other information you would like to share with the clinical team so that we can make an informed decision about your health?(Required)

Information such as family medical history or any other factors that may impact your health

Yes

Please provide the further information you would like to share with our team(Required)

Information to know about your Hair Loss Medication(Required)

You understand that if your partner is currently pregannt or trying to get pregnant they should not handle crushed or broken tablets of Finasteride and you should always wear a condom when having sex.
You understand that it may take up to 6 months before symptoms start to improve.
Some trials have suggested use of Finasteride may very slightly increase the risk of developing prostate cancer and male breast cancer. Do you agree to speak to your doctor immediately if you experience any changes in breast tissue such as lumps, pain or discharge from a nipple, impotence, problems with ejaculation, or less of libido.
This medication may reduce your prostate specific antigen (PSA) value on a blood test. You understand you must tell your doctor or anyone testing your PSA levels that you are taking this medication.
You understand that you must stop taking this medication immediately if you experience any mood alteration including depression, depressed mood or suicidal ideation and should contact a healthcare professional immediately if you experience these symptoms.
You confirm and understand that requesting treatment through our service does not guarantee a prescription if the treatment is unsuitable. In this instance, you will be refunded in full and signposted to another point of care. The decision about the treatment is for both patient and prescriber to consider; however, the final decision will always be with the prescriber.

I understand

We highly recommend that you tell your GP of any treatment that you receive privately. Are you happy for us to do this on your behalf?(Required)

Yes

Please enter your GP's email address(Required)

Do you agree to the following?(Required)

You are between the ages of 18-65
This treatment is for your use only
You have the capacity to make decisions about your own healthcare
You have understood all of the questions and have answered your consultation truthfully. It is important your answers are true and complete so we can ensure we are prescribing safely.
You will read all of the information within the patient information leaflet (PIL) provided with this medication
I understand the prescriber will take my answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health
I accept that prescription medication CANNOT BE REFUNDED once it has left our pharmacy. This is because the returned medication cannot be re-sold to another customer.
If you have not agreed for us to contact your GP on your behalf, you will make them aware that this medication has been prescribed to you so that your patient medication record can be updated
You are aware you will be subject to a soft check to validate your identity
You will contact Mens and inform your GP if you experience any side effects from this treatment or if there are any changes to your health
You have read and understood and agree to abide by our Terms and conditions of website use, terms and conditions of sale, privacy policy, delivery policy, refund policy and cookie policy

I agree to the above information

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