Hair Loss - WePrescribe

Hair Loss Consultation

When did you first begin losing your hair?

Over a year ago

Less than 3 months ago

Between 6 months and 1 year ago

Between 3 months and 6 months ago

Did your hair loss happen suddenly and quickly?

Have you or are you currently experiencing any of the following symptoms on your scalp area?

- Any unexplained spots or lesions - Any flaking - Any swelling - Any pain or inflammation

Is your hair loss occurring in random patches over your scalp?

Are you currently using any other products or treatments for hair loss?

If so, please provide more information

Please provide more details

Have you ever previously used treatment for hair loss?

If so, please provide more information

Please provide more details

Have you ever been diagnosed with any other medical conditions?

This can include: -Immune system conditions such as HIV -Liver or kidney issues

Please provide more details

Do you suffer with any allergies?

If so, please provide more information

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Do you currently take any medication? This includes herbal remedies and over the counter medication.

If so, please provide more information

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Is there any other information you would like to share with our prescribing team?

Please provide more details

We strongly recommend that you inform your GP of any treatment you receive. Would you like WePrescribe to do this on your behalf?

I have read and understood the Terms and Conditions.

Please see our terms and conditions here

Hair Loss Consultation