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Telephone: +44 (0) 203 176 0023

Questions Related to Hairloss

In order to prescribe treatments for Hairloss our doctor needs some information regarding this specific condition. Please complete the following as accurately as possible.


Please confirm the reason for wanting Hairloss treatment.

Where on your head are you losing hair? E.g. front, sides, crown etc.

How long have you been suffering with hair loss?

Please confirm you understand that pregnant or potentially pregnant women should not handle this medication directly.

Please confirm you understand that whilst using Propecia you should not have unprotected sexual intercourse.

Please confirm you understand that if you are planning to try for a baby over the next 6 months you should stop taking Propecia.

Are you suffering from complete or sudden hair loss (over a period of days or a few weeks), or hair loss caused by medication?

Do you suffer from an illness or skin condition that might explain hair loss such as psoriasis or ring worm (fungal infection)?

Do you suffer from prostate cancer or an enlarged prostate?

Do you have any skin diseases?

I understand that these tablets can ONLY be taken by men.

Do you suffer with depression or suicidal thoughts?