Your order request requires a prescription from our medical partner and prescriber The Compound Chemist. In order for us to request your prescription you are required to fill in the following medical questionnaire. Please answer the questions honestly and in full. All answers are treated in the strictest confidence and in line with our data protection policy. 

Please use the link below to download the medical questionnaire PDF and once complete save a copy and email to becci@houseoftrichology.co.uk along with a photo ID.