Health Assessment

You're Eligible for a Prescription!

Based on your hair test results, you are eligible for a prescription. To proceed, please create an account and complete your registration.

Scalp and Hair Health Assessment

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Your Mobile Number

Please enter your mobile number.

Confirm your Gender

Please select an option Thank you for your interest! At this time, this medicine is specifically designed for men.

Please enter your height and weight.

Please enter your height Please enter your weight We regret to inform you that we are unable to offer you treatment at this time as you are currently underweight This information helps us calculate your BMI to assess treatment eligibility

What is your age?

Please enter your age We regret to inform you that we are unable to offer you treatment at this time as you are currently underage We regret to inform you that we are unable to offer you treatment at this time as you are currently overage

How long have you been experiencing hair loss?

Please select an option

Are you currently undergoing any treatment for hair loss?

Please select an option Please specify the treatments

Are you currently taking any of the following medications: Advodart, Combodart, Duodart, Jalyn, Dutasteride, Proscar, Propecia, Finasteride?

Please select an option Please specify the medications

Do you experience symptoms of depression or are you currently taking antidepressants?

Please select an option

Do you have any medication allergies?

Please select an option Please specify the allergies

Have you ever had or do you currently have any of the following conditions?

Please select an option Please specify the conditions

Have you ever had or do you currently have any of the following scalp conditions?

Please select an option

Please check the boxes to confirm your commitment: