Your Consultation

    We are going to ask you a few questions so that we can give you the best medical care. It will take an average of 5 minutes to complete this form.

    We always try our best to help our patients, but due to some circumstance mean s our online service sometimes is not able to meet all your needs.

    Please be honest in your responses and if you are unsure about any of the questions, check these with your GP first.

    • I am 18 years old or above

    • I am using this service for my own self, of my own free will and any treatment or advice is for my sole use only

    • I will contact my GP if I need help filling out this form, reading or understanding this consultation

    • I understand my consultation will not be passed to the Volumize Hair Ltd clinicians until I have completed the questionnaire in full.


    Your Consultation

    What gender were you assigned to at birth?

    Your Consultation

    How old are you?

    Your Consultation

    What are your aims from this treatment?

    Your Consultation

    What changes do you anticipate Volumize will bring to your life??

    Your Consultation

    Which treatment option would you favor?

    Please keep in mind that the final treatment plans will be determined through collaborative discussions with your healthcare provider following this online assessment. Make sure to carefully review the information provided in the leaflet and the treatment plan.

    Your Consultation

    Which one of the below images best describes your hair loss?

    Your Consultation

    Have you experienced rapid hair loss or hair loss in specific patterns (e.g., male pattern baldness)?



    Your Consultation

    Are you currently experiencing any scalp or skin conditions that may affect the use of hair loss medications (e.g., scalp infections, psoriasis, eczema)?


    Your Consultation

    Have you previously tried any hair loss treatments or remedies?


    Your Consultation

    Do any of the following apply to you?

    Your Consultation

    Do you suffer from any of the following conditions?

    • Significant or Chronic Kidney Disease. Phaeochromocytoma.

    • Heart attack, stroke, or mini-stroke within the last 6 months.

    • Chest pain symptoms or any heart rhythm issues. Heart valve

    • problems. Disease of the heart muscles. Get breathless or have

    • chest pain with light exertion, such as walking briskly for 20

    • minutes or climbing two flights of stairs

    Your Consultation

    Do you have any history of allergies (eg Minoxidil, Finasteride, Dutasteride)?

    Your Consultation

    Is your scalp prone to dryness, irritation, or dandruff?

    Your Consultation

    Are you currently being treated for any other medical condition?


    Your Consultation

    What’s important to you?

    Your Consultation

    Do you understand and agree with the following?

    • I will read the enclosed patient information leaflet before I begin using my medicines

    • I will be the exclusive user of any medication provided to me via this service.

    • I have completed the medical questionnaire accurately and to the best of my knowledge

    • I will inform my regular GP about my treatment

    • The treatment is an unlicensed preparation manufactured in the UK.

    • It may take up to 6 months before I begin to see the effects of my treatment

    • Pregnant women should not be exposed to Finasteride or Dutasteride. I will not use the treatment if my partner is pregnant or trying to become pregnant

    • I will seek medical attention and stop taking the treatment if I experience any adverse side effects

    • If I have a blood test measuring my PSA levels, Finasteride and Dutasteride may alter the result and I will inform my doctor that I am taking this medication

    • My scalp is healthy and free of cuts, burns and inflammation

    • During my treatment, I understand that it is my duty to notify Volumize Hair Ltd of any new diagnoses of medical conditions made by a clinician, including any new medications that I will start taking.