Excessive hair consultation

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Name *

First

Last

Date of birth *

Email *

Phone *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Please indicate where you have thick or dark hair by selecting one or more of the following options. *

Upper lip
Chin
Sideburn area
Jawline
Neck
Other areas of the body

Could you please specify where on your body the unwanted hair appears? *

Has your facial hair been examined or investigated by your GP or another doctor? *

What is the cause for the excessive hair growth *

Have you experienced any of the following symptoms?

Sudden hair growth
Hair loss from the scalp, deepening of the voice, increased muscle mass, or an enlarged clitoris
Abdominal pain or swelling
Unexplained weight gain
Stretch marks or easy bruising
Abnormal vaginal bleeding or changes in discharge

Facial hair red flag one *

We’re sorry, but there are no suitable treatments for you.

The safety and well-being of our patients is our number one priority, and based on your answers, we can’t recommend any of our treatment options. We know this is both frustrating and disappointing, but we want to make sure that we’re putting your health first and that you find the right care.

If you’d like to speak to our clinicians about this, please email info@medicalmojo.co.uk. We’ll do our best to find a solution or recommend some safe next steps.

Note: If you made a mistake in your consultation, you can change your answers

Do you take any of the following medications?

Cyclosporine (used after organ transplants)
Glucocorticoids (e.g., for rheumatic or allergic diseases)
Minoxidil (for high blood pressure)
Phenobarbitone (for seizures)
Phenytoin (for seizures)
Hormone replacement therapy with male hormone-like effects, such as Androfem or Testogel.

Facial hair medicine red flag *

We’re sorry, but there are no suitable treatments for you.

If you’d like to speak to our clinicians about this, please email info@medicalmojo.co.uk. We’ll do our best to find a solution or recommend some safe next steps.

Note: If you made a mistake in your consultation, you can change your answers

Have you used Vaniqa (Eflornithine) before? *

Have you experienced any side effects from the treatment? *

Please can you tell us more about these adverse effects *

What is your biological sex? *

Male
Female

We’re sorry, but there are no suitable treatments for you.

If you’d like to speak to our clinicians about this, please email info@medicalmojo.co.uk. We’ll do our best to find a solution or recommend some safe next steps.

Note: If you made a mistake in your consultation, you can change your answers

Are you pregnant, breastfeeding, or trying for a baby? *

We’re sorry, but there are no suitable treatments for you.

If you’d like to speak to our clinicians about this, please email info@medicalmojo.co.uk. We’ll do our best to find a solution or recommend some safe next steps.

Note: If you made a mistake in your consultation, you can change your answers

Do you have any other medical conditions not already mentioned? *

Please provide more details *

Are you taking any other medications that have not already mentioned? *

Please provide information about any other medical conditions you have and any medications you are currently taking. Include the medication name, dosage, and how long you’ve been on it.

Other medication *

Do you have any other allergies that you have not previously mentioned? *

Please give us more details on these allergies *

Do you agree and consent to the following?

I am at least 18 years old and live in the UK.
I have the capacity to make decisions about your own healthcare
I shall be the sole user of any medication offered to me through this service.
I confirm all answers are provided by me and are truthful.
You understand the prescriber will take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health
If prescribed a treatment, I will read the Patient Information Leaflet (PIL) that will be provided.
If prescribed a treatment, I will inform my GP of my treatment and contact them if I have any side effects associated with the treatment.
You agree to our terms and conditions, privacy policy and acceptable use policy
You are aware you will be subject to a soft check to validate your identity using LexisNexis.

Checkboxes *

I agree to the statements and give my consent for any treatment provided.

Are you registered with a GP in the UK? *

(Optional) Do you consent to us accessing your NHS Summary Care Record (the medical details held by your GP) or requesting further information on your medical history from your GP?

Summary care records

I consent

(Optional) Do you give us consent to write to your GP to share information of this supply and any information we hold about you?

Send information to GP

I consent

Product Category

Important

We review all orders to ensure they’re the best treatment we can offer you. If what you ordered is unsuitable, we will refund part or all of your order.

If we decide what you ordered is unsafe for you, given the other information you provided, we won’t issue any treatment. However, we may call you and suggest alternatives.

Excessive hair consultation

Do you agree and consent to the following?

Conditions

Treatments

Care and policies