GoRocky Hair Loss Assessment

Medication
Please state all of the medications you currently taking.*

Antiviral MedicationNot taking any medicineOthers (Medicines not included in the choices)
You may place your medications here.
Do you have any allergies?
List all above (If None, put N/A).
Have you ever been treated for hair loss?
Please list all of the treatments you have taken before (If None, put N/A).
Anything else we need to know?
What is important to you when treating your hair loss?

I want the most convenient solutionI want the most effective solutionI want the cheapest solutionI want the most discreet solutionOther

Congrats!

Based on your answers, our doctors have pre-approved your use of medication.

Prescription will be sent to your email upon successful delivery of medication.
Enter your email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty:

Health History