Before we begin

Answer a few quick questions so our clinical team can check whether this service may be suitable for you before your consultation. This usually takes 2–4 minutes. Treatment is subject to clinical suitability.

I understand and want to continue.

Question 1 of 13

Full name

Question 2 of 13

Date of birth

Question 3 of 13

Postcode

Question 4 of 13

Email address

Question 5 of 13

Mobile number

Question 6 of 13

Are you completing this for yourself?

Yes No

Question 7 of 13

What is your biological sex?

Male Female Prefer not to say

Question 8 of 13

How long have you been experiencing hair loss?

Less than 6 months 6 to 24 months More than 2 years

Question 9 of 13

Is the thinning mainly at the hairline or crown (typical male pattern)?

Yes No

Question 10 of 13

Do you have any of the following?

Select all that apply.

Liver disease Prostate cancer None of the above

Question 11 of 13

Are you taking any regular medicines?

Yes No

Question 12 of 13

Please list your regular medicines

Include prescription medicines, over-the-counter drugs and supplements.

Question 13 of 13

Do you confirm that all the information you have provided is accurate and complete?

Yes No

Ready to submit

Your answers will be reviewed by our clinical team. Treatment is only supplied where clinically appropriate.