The online consultation

Step 1
3 minutes

Complete the questionnaire and create an account

Step 2
Within 24 hours

Medical assessment by a doctor

Step 3
± 3 business days

Discreet delivery via Dutch pharmacy

What gender were you assigned at birth?

Where do you notice hair loss?

What change do you notice in your hair?

Don't worry, you're definitely not alone. Hair loss occurs in an awful lot of people. The good news? Our treatment is effective for up to 90% of users.

How did your hair loss start?

What results are you looking for?

You are not alone!

More than 50% of women will experience hair loss at some point in their lives.

The good news? We specialize in helping you get thicker, fuller hair back.

Results can be seen in as little as 3-6 months!

What results are you looking for?

Do you have any of the following medical conditions?

Multiple answers possible

Results can be seen in as little as 3-6 months!

How does your scalp feel?

Are you pregnant, breast-feeding or planning to become pregnant?

Do you suffer from, or have you ever had, depression, anxiety, or panic disorders?

Kun je kort toelichten?

toelichting

Do you have any of the following medical conditions?

Multiple answers possible

Are you currently taking medication?

Om welk(e) medicijn(en) gaat het

How does your scalp feel?

You are almost there! Now we are going to ask you a few questions so that we can send you your treatment and your hair will grow again!

Are you currently taking medication?

Om welk(e) medicijn(en) gaat het

Tell us a bit more about yourself

First name
Last name
email
phone number
date of birth

You are almost there! Now we are going to ask you a few questions so that we can send you your treatment and your hair will grow again!

Where can we send your treatment?

Street name + house number
postcode
City
Land

Tell us a bit more about yourself

First name
Last name
email
phone number
date of birth

We need your social security number to prescribe your medication

BSN

This information is secure and is never shared. Your BSN is only used by the pharmacy to ensure that the medication is safe for you. Belgian customers are asked to fill in their RRN.

Where can we send your treatment?

Street name + house number
postcode
City
Land

Last step, please confirm the following points.

We need your social security number to prescribe your medication

BSN

This information is secure and is never shared. Your BSN is only used by the pharmacy to ensure that the medication is safe for you. Belgian customers are asked to fill in their RRN.

Last step, please confirm the following points.

Thanks for filling out the questionnaire! Click further to explore your treatment options.

Thanks for filling out the questionnaire! Click further to explore your treatment options.

Thank you! Your submission has been received!
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