Medicina Pharmacy

2

Consultation
Cart
Checkout
Payment

Medical Assessment

To help us supply you with the most suitable treatment, please complete this online consultation.

About You

Are you male and aged between 18-65?

We are unable to supply you with treatment.

Your Symptoms

Are you suffering from hair loss?

We are unable to supply you with treatment.

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

We are unable to supply you with treatment

Do you have a healthy scalp?

  • no inflammation on the scalp
  • no redness
  • no medical dressings
  • unshaven

We are unable to supply you with treatment. Please consult your GP

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

We are unable to supply you with treatment. Please consult your GP

Do you have sudden unexplained hair loss, or complete hair loss?

We are unable to supply you with treatment. Please consult your GP

Is your hair loss limited to the temple area?

We are unable to supply you with treatment. Please consult your GP

Your Health

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

We are unable to supply you with treatment. Please consult your GP

Do you have a history of depression or any other mental illness?

We are unable to supply you with treatment. Please consult your GP

Have you ever been diagnosed with one of the following conditions:

  • Heart Disease (including chest pain, angina, heart attack or any history of cardiovascular event)
  • High Blood Pressure
  • Pheochromocytoma (cancer of the adrenal glands)
  • Male breast cancer
  • Acute Porphyria (a rare hereditary disease affecting haemoglobin)
  • Prostate problems (prostate enlargement, prostatitis, prostate cancer)

We are unable to supply you with treatment. Please consult your GP

Your Medication

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

We are unable to supply you with treatment. Please consult your GP

Agreement

Do you understand that if you are prescribed finasteride and your partner is (or may be) pregnant, they should not handle crushed or broken tablets, and that you should always wear a condom during sex?

We are unable to supply you with treatment.

Do you understand that if you are prescribed finasteride, you should inform your GP of this before undergoing a PSA blood test for your prostate?

We are unable to supply you with treatment

Do you agree to the following?

  • You will read the patient information leaflet supplied with your medication
  • You will contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
  • The treatment is solely for your own use
  • You have answered all the above questions accurately and truthfully. You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health
  • You understand that whilst decisions relating to your treatment are made jointly between you and the prescriber, the final decision to issue a prescription will always be with the prescriber.

We are unable to supply you with treatment.

Complete our 2 minute questionnaire
Yasmeen Akthar

SuperIndependent Pharmacist

GPhC Reg 2058731

Mr. Saleh Ahmed

Independent Prescriber & Advance Practitioner

GPhC Reg 2065382

Mr. Mohammed Shajan Ali

Independent Prescriber

GPhC Reg 2067785

Need Help?

If you need help with this medical assessment, contact our helpline:

01604345869

or email us:

[email protected]

Fully Regulated

We are regulated by the General Pharmaceutical Council

UK-Registar

Learn More

Information

Contact Us

Pay Securely with

powered_by_yuma

© Medicina Pharmacy 2026. All Rights Reserved.

Company Number: 08402763

Unit 3, 11 Upper priory street, Northampton, NN1 2PT

UK-Registar

Pay Securely with

Our Charity
Partner
healthentrusts
UK-Registar

Medicina Pharmacy.

Company Number: 08402763

Powered-by-yuma-mobile