Before Proceeding to the Minoxidil Medical Consultation Form please read
CONTRAINDICATIONS and WARNINGS
and accept the Waiver of Liability
In order for Medical Wellness Center Physicians to provide you with the best care you need to reply honesty to all questions and you need to understand any and all risks and side effects associated with Prescription strength Minoxidil.
CONTRAINDICATIONS:
  • Do NOT use Minoxidil if you are under age 18
  • Do NOT use Minoxidil if you have any scalp irritation such as red, inflamed, irritated, sunburned or painful scalp.
  • Do NOT use Minoxidil if you have and skin diseases of the scalp such as psoriasis or eczema of the scalp.
  • Do NOT use Minoxidil if you ever had an allergic reaction to ROGAINE.
  • Do NOT use Minoxidil if you have any open wounds or lesions on the scalp.
  • Do NOT use Minoxidil if you do NOT know the reason of your hair loss.
  • Do NOT use Minoxidil if you are  experiencing a sudden hair loss
  • Do NOT use Minoxidil if you are experiencing hair loss secondary to a prescription medication or chemotherapy as it is NOT effective
  • Do NOT use Minoxidil if you are experiencing hair loss due to nutritional problems or thyroid problems.
  • Do NOT use Minoxidil if you are experiencing hair loss due to damage to the hair form a chemical treatment or hairstyle.
  • Absolutely no female will be prescribed Minoxidil online as male pattern hair loss in a women can be a sign of a severe life-threatening illness and even cancer.
  • Pregnant or potentially pregnant must woman NOT use Rogaine or Minoxidil .
  • Prescription strength Minoxidil can be formulated with or without a steroid.  Do NOT use Minoxidil formulated with a steroid if you have glaucoma, increased intraoccular pressure.
  • Do NOT use Minoxidil if you are allergic to any of the active or inactive ingredients - emollient creme base, preserved water, anhydrous ointment, BHT preservative polysorbate 80, propylene glycol base (you can request a glycerine base if sensitive to propylene glycol)
  • Do NOT use Minoxidil if you are using other medications on your scalp
IMPORTANT WARNING - STOP MINOXIDIL USE AND IMMEDIATELY SEE A DOCTOR IF YOU EXPERIENCE:
  • Unwanted facial hair growth
  • Chest pain, a rapid heartbeat, faintness or dizziness
  • Sudden, unexplained weight gain
  • Swollen hands or feet
  • Scalp irritation that continue or worsens


If allergic reaction occurs  - seek immediate emergency medical attention

MINOXIDIL SIDE EFFECTS:

The most common side effects are itching and other skin irritations of the treated area of the scalp.  Minoxidil should ONLY be applied to the scalp.  The risk of side effects increases if applied to other parts of the body.  Always WASH hands after use

Do not get in eyes - if accidentally gets in eyes flush with water immediately and if irritation persists seek immediate medical attention in an emergency room.

Stop using Minoxidil and seek emergency medical attention if you experience an allergic reaction such as difficulty breathing, closing of the throat, swelling of the lips, tongue or face.
 
 

IMPORTANT INFORMATION:

Minoxidil is to be used topically only.  Minoxidil  can be combined with systemic 5-alpha reductase inhibitors like Propecia or Avodart.

MINOXIDIL PRESCRIBING INFORMATION:

Prescription strength Minoxidil is available from a few select compounding pharmacies and is not available at your local pharmacy.  Medical Wellness Center prescriptions for topical prescription strength Minoxidil are filled directly by a compounding pharmacy.  You can request just the Minoxidil preparation without any additives or you can request Minoxidil with 0.025% Retinoic Acid,  or Minoxidil with 0.025% Retinoic Acid (initiates cell growth and differentiation), 5% Azelaic Acid ( a topical 5-alpha reductase inhibitor to help lower DHT levels) and Hydrocortisone ( a steroid to help minimize irritation.
Additives can only be added to the 12.5% minoxidil lotion, 15% and 30% minoxidil creams. You can also requests individualized custom compounded formulations similar to Dr. Klein's formulas.

I DO NOT HAVE ANY OF THE ABOVE CONTRAINDICATIONS:
By accepting "I Agree" means that you have read the above contraindication and warnings and honestly acknowledge that you do not have any of the above contraindications to Minoxidil therapy and understand that insurance will not cover the cost of the medication. 
I agree, proceed to Waiver of LiabilityI disagree

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