About You


Please provide your weight.



Please provide your height.


Do you smoke or drink?

Do you take any medication whether prescribed, over the counter, herbal/alternative or partake in any recreational drug use?

Do you have any allergies?

Have you been advised to avoid strenuous exercise?

Are you able to walk 3 miles or climb a set of stairs without pain in your chest?

Do you have any history of symptoms of anxiety or depression?


About your symptoms

How long have you been suffering from hair loss?

Are you or have you been treated or tested for:
  • Any problems with your prostate (enlarge prostate/BPH or prostate cancer)
  • Depression, anxiety, low mood
  • Changes in breast tissue
  • None

Are you currently taking Finasteride 1mg or Propecia?

Do you agree to stop taking finasteride and seeking medical attention if any of the following occur:
  • Low mood, depression or any thoughts of self-harm/suicidal thoughts
  • Changes in breast tissue such as enlarged breasts, lumps, pain or nipple discharge
  • Decreased libido, erectile dysfunction or ejaculation disorders.

Do you understand the following
  • If your partner is or can become pregnant you should use barrier methods of contraception and your partner should not handle hair loss treatment
  • You agree to tell your doctor you are taking hair loss treatment as hair loss treatment can affect the results of a PSA blood test.

Select Hair Loss Type
(Please select the option which best matches your current hair loss pattern.)

a. Are you pregnant or planning a pregnancy? (yes/no)
Taking Semaglutide/Ozempic/Saxenda whilst trying to conceive or during pregnancy can cause a risk to the unborn foetus. It is important to stop such medications at least 2 months prior to trying to conceive or as soon as you discover you are pregnant. Please get in touch if you have any questions.

b. Are you breastfeeding?


GP Details

Would you like us to inform your GP of your treatment?
We recommend informing your GP surgery of any treatment that you are taking to keep your medical records relevant and up to date



Do you agree to the following?
  • You have answered all of the above questions accurately and truthfully. You understand our prescriber(s) will prescribe medication based on your responses and interactions with Quick Meds. Any incorrect responses or deliberate acts to misinform may be hazardous to your health.
  • You agree to the terms and conditions, privacy policy and terms of use.
  • You will familiarise yourself with the patient information leaflet included with your order and any other information relayed to you via other means including IM/E-mail/telephone.
  • You will contact us and inform your GP if you experience any side effects to treatment, if there are any changes to your medical history including starting any new medications or new diagnoses, or if your symptoms/medical conditions change in any way.
  • You understand completing a purchase does not guarantee supply of treatment; the final decision to prescribe lies with the prescriber with your best interests, health and appropriateness in mind.
  • You agree to the terms and conditions, privacy policy and terms of use.