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Medication Review
Have you experienced any side effects on the medication?
Please choose one or more of the statements that apply to you regarding your hair loss at the moment*
Are you happy to continue with the same treatment regime?
What quantity of medication would you like*
Medical History Review
Has there been any change to your MEDICAL CONDITION(S) or have you developed any new health problems since your last review?
Has there been any changes to your current MEDICATION(S) or have you started on any new medications since your last review?
Has there been any changes to your current ALLERGY status or have you developed any new ALLERGIES?
Pharmacy Options
Questions from our Compounding Pharmacy
Have you taken this medication before?
Do you take any other medications (including Vitamins/Supplements)
Do you have any medical conditions?
Do you have any allergies?
Are you Pregnant/Breastfeeding?
Declaration
It is important that your General Practitioner knows what medication you are taking. Would you like us to inform them regarding this?