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Online Consultation

Please answer all questions honestly and completely so our health professional can ensure suitability and prevent any delays in supplying your medication

Are you purchasing this medication for yourself?
Are you male and over 18?
Do you currrently have or suffer with male pattern baldness?
Do you have any medical conditions or take any other medications including creams, ointments or any other skin preparations? (If you use skin preparations, please state where)
Do you use any recreational drugs?
Do you have any allergies?
Do you currently take any treatment for benign prostate hyperplasia?
Do you have a hereditary intolerance to galactose, lapp lactase deficiency or glucose-galactose malabsorption?
Have you previously tried finasteride 1mg for hair loss with unsatisfactory results, or taken dutasteride 0.5mg capsules for hair loss?
Do you, or have you ever suffered from heart failure, any form of liver disease, prostate cancer, benign prostate hyperplasia or breast cancer?
Do you have any of the following:
  • have a history of sensitivity to minoxidil, ketoconazole, ethanol or propylene glycol
  • suffer from treated or untreated high blood pressure, arrythmia or any other cardiovascular disease
  • suffer from Phaeochromocytoma
  • suffer from any current scalp issues including but not limited to infection, psoriasis, eczema, sunburn, broken skin or unspecified scalp pain, irritation, or inflammation
  • have a shaved scalp
  • have a condition where you use occlusive dressings
  • suffer from obstructive uropathy.
I will read the patient information leaflet before using any provided treatments.
I agree that
  • All questions have been answered to the best of my knowledge.
  • I understand that I should regularly have my blood pressure, glucose and cholesterol levels checked regularly with my GP.
  • I am happy for pharmacists to review my consultation and prescribe the items requested, if it is clinically suitable for myself.
  • I understand my treatment request may be rejected due to clinical or other reasons.
  • The treatment is solely for my own use and not for the use of others.
  • I consent for SPK Pharma Ltd to undertake an ID check to confirm my age and identity. (This will be done using a credit check agency, no record will be put on your credit rating).
  • Menschem will not inform my GP of this consultation, unless specifically requested via emailing [email protected] (please include GP name, address, and email address)
  • If you have used the requested medication before, you confirm it is working as intended.