Hair Loss

Are you male and over the age of 18 years who has male pattern baldness (androgenic alopecia)?

Please answer all questions accurately to ensure our clinicians can provide you with the best care.

Yes

No

Do you have a hypersensitivity to finasteride or any of the excipients?

Please answer all questions accurately to ensure our clinicians can provide you with the best care.

Yes

No

Are you taking any of the following medication:
• finasteride 5mg or any other 5a-reductase inhibitor for benign prostatic hyperplasia or any other condition
• anti-fungal, psoriasis or steroid creams on the scalp

Please answer all questions accurately to ensure our clinicians can provide you with the best care.

Yes

No

Do you suffer from obstructive uropathy?

Please answer all questions accurately to ensure our clinicians can provide you with the best care.

Yes

No

Do you have a rare hereditary problem of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption?

Please answer all questions accurately to ensure our clinicians can provide you with the best care.

Yes

No

Are you suffering from hair loss related to a medical condition that is not male pattern hair loss (e.g. seborrheic dermatitis, cancer)?

Please answer all questions accurately to ensure our clinicians can provide you with the best care.

Yes

No

Have you had a hair transplant?

Please answer all questions accurately to ensure our clinicians can provide you with the best care.

Yes

No

Do you suffer from severe liver disease?

Please answer all questions accurately to ensure our clinicians can provide you with the best care.

Yes

No

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Hair Loss

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