Agreement
Please read the below agreement in full.
By agreeing to these terms, I acknowledge that the information I have provided will be disclosed to the prescriber responsible for my prescription. I understand that the prescriber may need to contact me to discuss my medical history or address any concerns regarding my prescription.
I understand that I would need to take the prescribed treatment for at least 3-6 months before I see any benefit and stopping treatment will reverse any regrowth and hair loss will resume.
I confirm that I have understood the questions asked, I have answered them honestly and that the treatment I am requesting is for myself only. I understand the side effects and other treatment options available. I also understand that I can contact the prescriber for more information.
I understand the risks and potential side effects associated with this medication and I understand that I have the opportunity to ask any questions regarding this treatment.
I understand that as my prescription is customised specifically for me and is an unlicensed medication. Unless directed otherwise, the prescriber will send this prescription directly to the Compounding Lab Ltd T/A Compounding Chemist, who will compound the medication to the standards underpinned in Section 10 of the Medicines Act 1968.
Medication will be delivered to the address confirmed at the time of order and will be delivered through a courier tracked service.
Your confidential information will be processed and used for the above services under the current data protection requirements.
If you would like to change or withdraw your authorisation for any of the above services, please contact a member of the pharmacy team who will update your preferences on info@cchemist.com or 0203 7732 729.
By signing this form, I acknowledge and consent to the statements outlined in this consultation form.
