About your General Health To help us provide the right treatment or advice for you, please answer the following questions about your overall health. If you get stuck or need any help, you can contact us.
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Back When did you first begin losing your hair?
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?
Have you ever previously used treatment for hair loss?
Are you currently using any other products or treatments for hair loss?
Have you ever been diagnosed with any other medical conditions? This can include:
-Immune system conditions such as HIV -Liver or kidney issues Do you suffer with any allergies?
Do you currently take any medication? This includes herbal remedies and over the counter medication.
Is there any other information you would like to share with our prescribing team? If so, please provide more information
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