Hair Removal - WePrescribe

Hair Removal Consultation

Are you a female?

What is your D.O.B (dd/mm/yyyy)

Are you currently experiencing excess hair growth around the face, chin or upper neck area?

Which of the following describes your excess hair growth?

Thick, coarse, long hair

Soft, short, fine, clear hair

Have you noticed any sudden, rapid or hair growth you would say is unusual recently?

Have you recently experienced or suffered from any of the following?

- Significant unexplained weight gain - Severe acne - Irregular periods - Loss of hair from the scalp area - Voice deepening - Increase in muscle bulk around the body

Have you ever previously been diagnosed with a liver condition?

Have you ever previously been diagnosed with a kidney condition?

Have you ever previously been diagnosed with any other medical conditions?

This includes conditions such as - Asthma - Kidney disease - Liver disease - Eczema

Please provide more details

Do you suffer with any allergies?

If so, please provide more information

Please provide more details

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

If so, please provide more information

Please provide more details

Are you pregnant, planning a pregnancy or breast-feeding at the moment?

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

If so, please provide more information

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 Removal Consultation

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