Top Health Center

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One Time Consulting Charges: $49.99 (USD)

The above payment is for consultation only and does not cover the cost of your medication. Top Health Center will only send your prescription to your pharmacy of choice.

1 - What best describes your hair and where you are noticing hair loss? Select all that apply.*

2 - How long ago did you first notice any signs of hair loss?*

3 - What sort of results are you looking for?*

4 - Do any of the following currently apply to you? *

5 - Have you seen a doctor in the past for any hair-related symptoms? *

6 - Have you tried any of these treatments? *

7 - Was your past treatment effective?

8 - Have you experienced any reactions more than 4 weeks after starting a past treatment?*

9 - Do you experience any symptoms of sexual dysfunction?*

10 - Do you have or have you had any medical or mental health conditions? *

11 - In the last two weeks, have you been troubled by any of the following?*

12 - Please list any additional medical conditions, surgeries, or hospitalizations you have had.

13 - Do you take any medicines, vitamins, or supplements?

14 - Please list any allergies you have.

15 - Is there anything else related to the treatment that you'd like to ask or discuss with your medical provider?

16 - Do you have a preference on medication type? *

17 - Do you have a preferred treatment?*

18 - Do you have a preferred dose or strength?

19 - Please enter preferred pharmacy information.*

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