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What is your biological sex? (at birth)

Do you need help completing this questionnaire?

Yes

Do you believe that you have the capacity to make decisions about your own healthcare?

Yes

Have you been diagnosed with any medical conditions?

Yes

Are you currently taking any medication? This includes prescription-only, over-the-counter and homeopathic medicines.

Yes

Do you suffer from any allergies?

Yes

Is there anything else you would like to include to allow our prescriber to prescribe responsibly?

Yes

Have you seen your doctor before regarding your facial hair problem?

Yes

Vaniqa is for LONG TERM use and I understand that it could take up to 4 months to see the effects?

Some people have seen improvement in 8 weeks, however it is person specific. We want to make sure you understand all medication is the same but works differently for everyone.

Yes

I am aware that Vaniqa is not used for hair removal, it just slows down the hair growth?

Vaniqa slows hair growth down, however for best results you can use something to remove the hair as well

Yes

I Understand that: That I should not stop any prescription medication that I take regularly whilst using Vaniqa That Vaniqa should only be used on the face and nowhere else on the body as it is untested everywhere else.

Yes

Are you pregnant, breastfeeding or trying to have a baby?

Yes

Do you agree to the following:

You confirm that your answers are truthful and will guide medical decisions, agree to read the medication leaflet, accept DrWeightmans Pharmacy’s terms, confirm the treatment is for personal use, and will notify your GP if needed.

Yes

To support your care, we kindly ask for your GP details. If treatment is supplied, we may notify them. Providing accurate information helps avoid any delays.

Enter GP details Manually or search via GP postcode/name.

Yes

Assessment

Excessive Hair / Hirsutism Consultation

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