About your Health
To help us understand that this treatment is the right option for you, please answer the following questions. If you get stuck or need any help, you can contact us.
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Are you male by biological birth?
Only males are able to take this medication
How long have you been affected by male pattern baldness?
Please select one option A period of 0 to 3 months 3 - 12 months Years 1 to 3 three years or longer
Are you currently receiving any treatment or under any medication?
Please provide more information of the medication being used if any.
Can we share this information with your General practitioner?
Providing us with your physician's address means that you allow us to share this information with him/her for updated medical records if need be. It also allows our clinician to access your medical records if there is a need for that. We advice you share this treatment with your doctor for him/her to update your medical records.
Have you been using Finasteride tablet to cure hair loss?
How frequently do you monitor your blood prssure? Do you frequently visit your doctor?
Has a certified medical practitioner ever informed you of how high or how low your blood pressure is?
It could either be your personal doctor, another certified medical practitioner or through home self-test kits
Have you been using Regaine tablet to cure hair loss?
If so, for how long have you used it and how successful was it?
Can you relate to any of the following statements?
You have or have had stomach or duodenal ulcers, as well as stomach or intestinal bleeding in the past.
Are you aware that Finasteride (Propecia) may be present in sperm and that you must use a condom during sexual activity when taking this medication?
Did you know that using a higher dose of a hair loss therapy will not improve its effectiveness?
Clinical trials have indicated that the recommended amount is the most effective for hair loss, and that raising your dose or mixing Avodart (dutasteride) and Propecia has no extra benefit (finasteride). Increasing your dose or combining therapies will not improve or speed up your outcomes, but it will make you more susceptible to side effects.
Have you been using Propecia tablet to cure hair loss?
If so, for how long have you used it and how successful was it?
Are you aware of the following:
It is never a good idea to self-diagnose and treat urine incontinence.
Do you conscent to stop the consumtion of Finasteride immediately and seek medical help if you experience any of the following symptoms:
A depressed mood, despair, or suicidal thoughts
Have you been using Finasteride 1mg pills (Propecia)
If so, how successful was it?
Have experienced any side effects with Finasterid before?
If yes, please proivide as much detail as possible.
Are you being treated or tested for:
If Yes, please proivide as much details as possible
How long have you been suffering with male pattern baldness?
Please indicate in months/years
Did you know that Propecia is only for men and that it can affect women, especially those of childbearing age, if they come into contact with it?
Do you realize that this medication is being prescribed 'off-label'?
Using the extra information option, you can learn more about off-label medicines.
Do you have any recent or past medical history of note?
If yes, please provide details
Have you had a serious reaction to any hair loss medicines before?
Do you suffer from any scalp conditions (such as fungal infection)?
Have you had any rapid weight loss in the past 6 months?
Is the progression of your hair loss symmetrical (the same on the right as on the left side of your scalp)?
Is the hair loss only located at the temples or the side of the forehead?
Is your hair loss in clumps/patches, or is the hair loss rapid?
Do you understand that regrowth of hair can take up to 6 months and is most effective up to 2 years?
Do you have any problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption?
Do you have any chronic medical conditions (e.g. cancer)?
If yes, please provide details
Do you have any allergies?
If yes, please provide details
Do you agree to tell your doctor or pharmacist about any side effects you may be experiencing with the medicines and any progression of symptoms?
Do you understand that any hair growth may be lost 6-12 months after treatment?
Is your hair loss accompanied by any red, inflamed, scaly or itchy skin?
Do you have depression, generalized anxiety disorder, psychosis, schizophrenia, or any other psychiatric disorder?
Do you have a history of depression, generalized anxiety disorder or any other psychiatric disorder?
Do you suffer from bladder obstruction (obstructive uropathy)?
Do you have any liver problems (hepatic impairment)?
Are you aware that crushed or broken tablets of finasteride should not be handled by women when they are or may potentially be pregnant?
Are you aware that you should tell your doctor you are receiving treatment before having a prostate-specific antigen (PSA) test?
Please list all your current prescription medication including any medication you buy over the counter...
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