2nd Floor, Akerman Health Centre
60 Patmos Road, London, SW9 6AF
Tel. 020 3582 0000
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Male Pattern Baldness Online Consultation

Please fill out the form below, and one of our doctors will contact you regarding the consultation:

Patient Information

Name: *
Date Of Birth: *
NHS Number (if known):
Address:
Postcode:
Contact Number: *
E-Mail Address: *

Consultation Information

1. Have you read information about your symptoms on Patient.info?

    It is advised that you read up about this condition and the related symptoms.

    Yes

    No

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

    • Irregular patchy hair loss needs investigation.
    Please see your regular doctor for examination before using hair loss treatments. We are unable to provide treatment.

    Yes

    No

    3. Do you have sudden unexplained hair loss, or complete hair loss, or hair loss caused by medication?

    • Hair falling out in clumps or over a period of days or weeks needs investigation.
    Please see your regular doctor. We are unable to provide you with hair loss treatment as it may not work and investigation is required.

    Yes

    No

    4. Are you suffering from an illness or skin condition that might explain hair loss?

    • e.g. disease causing weight-loss or fevers
    • e.g. skin conditions such as psoriasis or ring worm (fungal infection)
    Please see your regular doctor. We are unable to provide you with hair loss treatment as it may not work.

    Yes

    No

    5. Are you aware that Propecia tablets / finasteride 1mg are for men only?

    • Propecia /finasteride 1mg will not work in women and may be harmful in pregnancy.
    Propecia tablets / finasteride 1mg will not work in women and can cause harm in pregnancy. You can change your answer and continue.

    Yes

    No

    6. Are you already taking Propecia tablets / finasteride for a condition apart from hair loss?

    • Finasteride 5mg tablets (Proscar) are sometimes used to treat prostate enlargement.
    If you already take Finasteride 5mg tablets (Proscar) for something apart from hair loss please see your regular doctor about hair loss. We are unable to provide you with treatment.

    Yes

    No

    7. Do you have significant low blood pressure, abnormal heart rhythm or angina?

    • Only significant if requesting Regaine topical application. If ordering Propecia only please answer 'No'.
    Please see you regular doctor before using Regaine topical applications. For Propecia tablets, low blood pressure, abnormal heart rhythm or angina are not significant and you can change answer to 'No'.

    Yes

    No

    8. Do all of the following apply to you?

    • I will read the patient information leaflet supplied with my medication.
    • The medication is for my own use. (Partners, spouses etc must log out, complete their own consultation and register separately)
    The conditions must apply for you to be able to use this service.

    Yes

    No

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