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Medical Assessment

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About You
Are you male and aged between 18-65?
    This treatment is not suitable for women, or those under 18 or over 65.
    Please complete this question.
    Your Symptoms
    Are you suffering from hair loss?
      We are unable to supply you with treatment if you are not suffering from hair loss. Please consult your GP or doctor for more information.
      Please complete this question.
      Could your hair loss be explained by any medication, dietary matter or illness?
        If a lifestyle or health factor is causing your hair loss, we recommend speaking to your GP or doctor for further advice.
        Please complete this question.
        Do you have a healthy scalp?
        • no inflammation on the scalp
        • no redness
        • no medical dressings
        We are unable to supply you with treatment. Please consult your GP or doctor.
        Please complete this question.
        Do you have hair loss in patches, or have an itchy or sore scalp?
          This treatment is not suitable for you. We recommend contacting your GP or doctor for further advice.
          Please complete this question.
          Do you have sudden unexplained hair loss or complete hair loss?
            This treatment isn't suitable for this type of hair loss. We recommend you speak to your GP or doctor for further advice.
            Please complete this question.
            Is your hair loss limited to the temple area?
            We may still be able to offer you hair loss treatment, but with a limited medicine range.
            Please complete this question.
            Your Health
            Are you allergic/hypersensitive to minoxidil, finasteride/propecia, ethanol, propylene glycol or lactose?
              This treatment is not suitable for you.
              Please complete this question.
              Do you have a history of depression or any other mental illness?
              We will still be able to offer you treatment, but with a limited product range.
              Please complete this question.
              Have you ever been diagnosed with one of the following conditions:
              • Heart disease (including chest pain, angina, heart attack or any history of cardiovascular event)
              • High blood pressure
              • Pheochromocytoma (cancer of the adrenal glands)
              • Male breast cancer
              • Acute porphyria (a rare hereditary disease affecting haemoglobin)
              • Prostate problems (prostate enlargement, prostatitis, prostate cancer)
              This treatment is not suitable for you.
              Please complete this question.
              Your Medication
              Are you currently taking any medication (over-the-counter or prescription) or any recreational drugs?
              Are you taking any of the following medications?
              • Dithranol — used to treat psoriasis
              • Tretinoin — used to treat acne or other skin disorders
              • Corticosteroids — hydrocortisone or betamethasone dipropionate
              • Petrolatum — a common ingredient in hair wax and gel
              We are unable to supply you with treatment. Please consult your GP or doctor for more information.
              Please complete this question.
              Agreement
              Do you understand that if you are prescribed finasteride and your partner is (or may be) pregnant, they should not handle crushed or broken tablets, and that you should always wear a condom during sex?
                We are unable to supply you with treatment unless you understand and agree to this point.
                Please complete this question.
                Do you understand that if you are prescribed finasteride, you should inform your GP of this before undergoing a PSA blood test for your prostate?
                  We are unable to supply you with treatment unless you understand and agree to this point.
                  Please complete this question.
                  Do you agree to the following?
                  • You will read the patient information leaflet supplied with your medication
                  • You will contact us and inform your GP of your medication if you experience any side effects of treatment, you start new medication and/or your medical conditions change during treatment
                  • The treatment is solely for your own use
                  • You have answered all the above questions accurately and truthfully
                  • You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health
                  • You understand that whilst decisions relating to your treatment are made jointly between you and the prescriber, the final decision to issue a prescription will always be with the prescriber
                  You must agree to this before continuing. If you need assistance contact our customer support.
                  Please complete this question.
                  Complete our 2 minute questionnaire
                  We’re almost done!
                  Ana Carolina Osorio De Faria Goncalves
                  To find a treatment suitable for you, we just need you to answer a few questions.
                  Ana Carolina Goncalves
                  Superintendent Pharmacist
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                  Lowest Price Guarantee

                  We're so confident you won't find your treatment cheaper, that if you do, we'll refund the difference for up to 14 days!

                  Need help?

                  If you need help with this medical assessment, contact our helpline:

                  0207 112 9014

                  or email us:

                  help@pharmica.co.uk
                  Fully Regulated

                  We are regulated by the General Pharmaceutical Council

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