Question 1. Eligibility and declaration

This questionnaire forms the basis of your online consultation. Please confirm the following statements are true:

- I am 18 years old or over.
- I am using this service on my own behalf and of my own free will.
- Any treatment or advice provided is for my personal use only.
- I confirm that the information I provide is true, accurate, and complete.

Question 2. Are you an existing Hair Formulas customer?

If Yes, the customer will be sent to log in.

Question 3. Have you previously been diagnosed with male pattern baldness?

Question 4. Which best describes your hair loss?

Please select the image that best matches your pattern of hair loss.

Note: Our prescription treatments are intended for male pattern hair loss (androgenetic alopecia) and are not suitable for conditions such as alopecia areata.

Pattern 1 Pattern 2 Pattern 3 Pattern 4 Pattern 5 Pattern 6 Pattern 7Other / unsure

Question 5. Have you experienced rapid hair loss?

Question 6. Have you ever taken Finasteride or Propecia before?

Question 6A. Did you experience any side effects when taking Finasteride or Propecia?

Question 6B. Please provide more details about the side effects you experienced when taking Finasteride or Propecia.

Question 7. Have you ever taken Minoxidil or Regaine before?

Question 7A. Did you experience any side effects when taking Minoxidil or Regaine?

Question 7B. Please provide more details about the side effects you experienced when taking Minoxidil or Regaine.

Question 8. Have you ever been diagnosed with any of the following?

Select all that apply.

Question 8A. Please provide more details about your diagnosis.

Question 9. Are you taking any medication?

Question 9A. If yes, which medications and for what reason.

Question 10. Consent and confirmation

Please read the following carefully and confirm that you agree:

- I understand that I should read the patient information leaflet supplied with any medication prescribed to me.
- I understand that it is considered best practice to inform my GP of any private treatment I receive.
- I understand that my consultation and treatment details will be handled confidentially.
- I confirm that I have answered all questions honestly and have provided complete and accurate information about my medical history and current health.
- I confirm that I understand the questions and information provided. If I am unsure about any aspect of the service, I will contact the prescribing service before proceeding.
- I understand the possible side effects, expected benefits, and available alternatives to the treatment I am requesting.
- I have read, understood, and agree to the latest Hair Formulas Terms & Conditions and Privacy Policy.

Important information about Finasteride
Finasteride 1mg is generally licensed for use in adult males with male pattern hair loss. Use outside standard licensed criteria may be considered off-label, at the prescriber’s discretion. As a precaution, patients are often advised to discuss Finasteride use with their prescriber if they are trying to conceive with a partner or have any concerns regarding pregnancy exposure.

Marketing consent

Would you like to receive marketing communications from Hair Formulas by email?