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Online Appointments
- - Online Appointments - Coming Soon!
  GPs
- Psychologists
- - Frequently Asked Questions
    View all
  FAQ
- - Why choose Simple Online Doctor
    Our AHPRA registered health professionals are online and ready to help
    Australian Registered
    Convenient
    Easy to use
  Why Us
- - How it Works
    Make Appointment
    Make an appointment with one of our health experts for an online video consultation
    Information
    Complete a form to give us some information about why you want to chat to a doctor, and complete payment for your appointment
    Get Online
    Just be online at the correct time, and start your online consultation with one of our GPs
    Find Out More
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Assessment Progress

1Your Hair Loss
2Your health
3Consent

Assessment

Ordered Before? Log in now, and save time completing your assessment.

Item added to bag. Click here to view bag.

Please select a size from above to proceed.

There are NHS prescriptions in your basket. Please complete the order first or remove NHS prescriptions from the basket.

Patient Notice! This questionnaire forms the basis of your hair loss consultation today. We need you to be honest with your answers including any current medication you are on. This allows our doctors to safely prescribe medication and offer accurate advice. We expect you to read the medicinal information provided before using your treatment.

1Your Hair Loss

Have you taken Propecia or Finasteride before? *

NoYes

Did you take Propecia or Finasteride for more than 4 months? *

NoYes

Was Propecia/Finasteride successful in preventing further hair loss or regrowing your hair? *

NoYes

If finasteride has not prevented further hair loss or successfully regrown hair after 4 months of treatment, you should discontinue use.

You will need to speak to your GP about additional treatment options.

Did you suffer from any adverse effects from your Propecia/ Finasteride Treatment? *

NoYes

Please provide information of the side effects experienced *

Please select the pattern of your hair loss according to the chart below.

hair loss

Do you understand Propecia (Finasteride) is for men between 18-65 only?

NOTE: Propecia / Finasteride will not work in women and can be harmful during pregnancy *

NoYes

You must understand this information to proceed. If you are not a male aged between 18 and 65, please refer to your GP for a face to face consultation.

Was your hair loss either sudden or medication induced? *

NoYes

Unfortunately we can not offer you treatment, as sudden or unexplained hair loss is best discussed with your own GP.

Does your hair fall out in patches? *

NoYes

Please see your GP to discuss treatment options.

Irregular or patchy hair loss should be investigated for underlying causes by your doctor.

Are you suffering from an illness or skin condition that might explain your hair loss? e.g. Disease causing weight-loss or fevers or skin conditions such as psoriasis or ring worm *

NoYes

Please see your GP to discuss treatment options.

You may be able to treat underlying causes to reverse or slow hair loss.

Is your scalp red, inflamed, irritated, infected or painful? *

NoYes

These treatments may not be suitable. You may be able to treat the underlying causes to reverse or slow your hair loss. Please see your GP to discuss treatment options.

2Your health

Have you ever been diagnosed with or are you currently under investigation for any prostate conditions (including prostate cancer)? *

NoYes

Unfortunately we can not offer you treatment. You can discuss treatment options with your GP in this instance.

Do you have any other health problems or conditions that you think we should know about? e.g. recent or major operations, G6PD, mental illness, neurological conditions etc. *

NoYes

Please give more details *

Do you suffer from any problems with your kidneys, your urinary system, your digestive system or your liver? *

NoYes

Unfortunately we can not offer you treatment. You can discuss treatment options with your GP in this instance.

Are you currently taking any prescription-only medicines, alternative medicines or recreational drugs? *

NoYes

Please list your current prescription, over the counter and alternative medicine(s) including the dose. *

Do you have any known allergies to any medicine or substances? *

NoYes

Please give more details *

3Consent

Please confirm you aware that some users of Propecia / Finasteride may experience depression or suicidal thoughts?

NOTE: You should discontinue use and see your GP if you are experiencing low mood or think you might be experiencing depression

*

Confirm

Please confirm you aware that Finasteride / Propecia can cause erectile dysfunction in around 1-2% of users? *

Confirm

I confirm I am over 18 years old.

The medicine ordered is for my sole use only.

I will read the patient information leaflet supplied with the medicine specifically the side effects and dosages.

I take responsibility to inform my own regular doctor of the online consultation or any changes in my circumstances.

I agree to the Simple Online Doctor terms and conditions. *

Confirm

Cancel Assessment

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