HAIR

When did you start noticing your hair loss? *

Less than 1 year ago

1-5 years ago

More than 5 years ago

I’m not sure

HAIR

With treatment which results were you hoping for? *

Regrow my hair

Prevent further hair loss

Regrowth and prevention

We’ve helped thousands of men like you keep the hair they have.

Now, help us understand your lifestyle and background.

Understanding the root causes of your hair loss will help us to better understand your needs.

LIFESTYLE

Does hair loss run in your family? *

Yes

Not sure

Why are we asking?

Hair loss often runs in families and is usually hereditary. If an immediate family member has experienced hair loss, there's a higher chance it could affect you too.

LIFESTYLE

How often do you feel stressed? *

All the time

Sometimes

Rarely

Not sure

Why are we asking?

Stress can have a significant impact on your hair. It can trigger or worsen a temporary condition called telogen effluvium, which disrupts your hair's natural growth cycle.

Hair shedding and thinning can often be linked to factors like family history and stress.

The good news is that, with treatment, you could see results in 3 - 6 months!

We just need to know a bit more about your health history – this won't take long.

YOUR HEALTH

Have you tried any of the following treatments? *

Minoxidil or Regaine

Finasteride or Propecia

No, I’ve not tried any of these

YOUR HEALTH

Were Minoxidil or Regaine effective at treating your hair loss? *

Yes

Not sure

Full Name

Email *

Phone *

Lastly, do you agree and consent to the following?

I am male, between 18 and 65 years old and live in the UK.
I will be the sole user of any medication offered to me through this service.
All answers are provided by me and will be completely truthful
I confirm that I am experiencing male pattern baldness (androgenetic alopecia)
I am aware that minoxidil 10% spray, minoxidil spray with topical finasteride, oral minoxidil and All In One capsule are prescribed as unlicensed products
I will inform MANUAL or my GP if I begin to experience low mood, depression or suicidal thoughts
I agree to inform the service of any changes to my medical history to ensure clinicians are informed and, if necessary, re-assess my suitability for treatment.