Hair Loss Prescription

Start Your Consultation

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Do you agree and consent to the following?

You are completing this consultation for yourself and to the best of your knowledge.
You will disclose any medical conditions, serious illnesses or operations you have had.
You will disclose any prescription medications you are currently taking and agree to use only one weight loss treatment at a time.
You agree to our Terms & Conditions, Terms of Sale, and confirm that you have read our Privacy Policy.
Your accurate and honest responses to this online questionnaire for weight loss treatment are crucial. Withholding or providing false information can severely harm your health and may result in life-threatening consequences. By filling out this questionnaire, you confirm that your responses are truthful and accurate, acknowledging the potential risks of misinformation.
You agree to undergo identification and age verification. This may require submitting valid documents to our approved third-party verification partner for validation.
You consent to EveryDayMeds accessing your Summary Care Record (SCR) for the purpose of ensuring the safe supply of treatment. If the SCR is unavailable or incomplete, you agree to participate in appropriate two-way communication (e.g. phone, secure message, or video consultation) to verify your medical history. If you do not respond or engage, your order will be cancelled.

Your Health

Are you male and aged between 18 and 65?

Yes No

Are you allergic/hypersensitive to minoxidil, finasteride/propecia, ethanol, propylene glycol, or lactose?

Yes No

Do you have a history of depression, suicidal thoughts and/or any other mental illness?

Yes No

Have you ever been diagnosed with one of the following?

Heart disease (angina, heart attack, cardiovascular events)
High blood pressure
Pheochromocytoma (adrenal gland cancer)
Male breast cancer
Acute porphyria
Prostate issues
Liver disease
Obstructive uropathy

Yes No

Medical Condition

Are you suffering from hair loss?

Yes No

Could your hair loss be explained by any medication, dietary factor, or illness?

Yes No

Do you have a healthy scalp (no redness, inflammation, or dressings)?

Yes No

Do you have hair loss in patches, or an itchy or sore scalp?

Yes No

Do you have sudden unexplained or complete hair loss?

Yes No

Is your hair loss limited to the temple area?

Yes No

Have you been taking Finasteride for more than 3 months?

Yes No

Have you noticed a visible reduction in hair loss since starting Finasteride?

Yes No

Have you experienced any sexual side effects (e.g. erectile dysfunction, low libido, ejaculation disorders) since starting Finasteride?

Yes No

Some studies suggest Finasteride may cause sexual side effects including low sperm count or volume. These effects are usually reversible, but rarely may be permanent. Are you happy to continue with Finasteride?

Yes No

Have you experienced any psychological side effects (e.g. depression, suicidal thoughts) since starting Finasteride?

Yes No

Medication

Are you currently taking any medication (over-the-counter or prescription) or recreational drugs?

Yes No

Are you taking any of the following?

Dithranol (for psoriasis)
Tretinoin (for acne)
Corticosteroids (e.g. hydrocortisone, betamethasone)
Petrolatum-based products
Finasteride for other conditions (e.g. BPH)
Other 5AR inhibitors (e.g. Dutasteride)

Yes No

Agreement

Do you understand that if prescribed Finasteride and your partner is pregnant (or may be), they should not handle crushed tablets, and condoms should be used during sex?

Yes No

Do you understand you must inform your GP before a PSA blood test if taking Finasteride?

Yes No

Do you understand that Finasteride may temporarily affect fertility if you are planning to conceive?

Yes No

Do you understand Finasteride may cause depression and suicidal thoughts? If this happens, stop taking it and contact your doctor.

Yes No

Do you understand that sexual side effects may occur and persist after treatment stops?

Yes No

Do you agree to the following?

You will read the leaflet provided
You will contact your GP if you experience side effects or changes
You will use the treatment for personal use only
You have answered truthfully
You understand incorrect answers could affect your health
Final prescribing decisions rest with the clinician

Yes No

Do you give us permission to access your NHS Summary Care Record or request medical history from your GP if required?

Yes No

Do you consent to us sharing relevant consultation details with your GP to ensure continuity of care?

Yes No

GP Consultation

We can notify your GP of your treatment for you. To do so, we need their contact information. Sharing this information allows your GP to maintain a comprehensive record of your medical history, which is crucial for your health. Without complete records, there could be potential risks to your well-being.

I consent to EveryDayMeds contacting my GP and share information about my prescription.

Yes No

Practice/GP Name

Practice/GP Address

Identity Verification

Please upload your identification documents.

Would you like to upload documents now?

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What you need to upload

To safely prescribe weight-loss medication, our clinicians need to verify your identity and assess your eligibility. Please upload both of the following:

Photo ID

Upload a clear photo of one valid ID document, such as:

Passport
UK driving licence
National ID card

Requirements:

The full document must be visible
Text and photo must be clear and readable
The ID must be valid (not expired)

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Tap to upload ID card

No file chosen

Full-Body Photo

Take a full-body photo of yourself using your camera.

Photo guidelines:

Full body visible (head to feet)
Wear fitted clothing (no coats or baggy clothes)
Stand straight, facing the camera
No filters or edits

This photo is used only to help our clinicians assess your BMI and suitability for treatment.

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Take photo using camera

Camera required

Upload Previous Prescription

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Upload previous prescription

No file chosen

If you select this option, your order won’t be approved until all required documents are submitted. After your consultation, we’ll email you instructions on how to upload your documents.

Your Hair Loss Prescription Plan

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