Confirmation Required
If you proceed with an order, our doctor will call you on the below number to explain potential side effects and answer any questions you may have. Please ensure that your phone number is correct as the doctor cannot write a prescription without speaking with you first.
Answer seven quick questions about your general health to get the most effective clinically proven treatments for you.
DO YOU AGREE AND CONSENT TO THE FOLLOWING?- I live in Australia.
- I shall be the sole user of any medication offered to me through this service.
- I confirm all answers are provided by me, and will be truthful.
- I agree to the terms and conditions.
press Enter ↵
1
Would you like to skip the questionnaire and speak with a Doctor instead?
NEW
2
Do you take any regular medications, have any known allergies or any medical issues?
3
Please list any regular medications you take, any known allergies or any medical issues.
Shift ⇧ + Enter ↵ to make a line break
press Enter ↵
1
Do you have any issues with hair loss/ receding hair line/ balding?*
2
Is the hair loss mainly at the front (scalp), middle (crown) or back/sides (patchy)?*
3
Have you tried anything for the hair loss?*
4
What have you tried?
Shift ⇧ + Enter ↵ to make a line break
press Enter ↵
4
Do you have any allergies?*
5
What allergies do you have?
Shift ⇧ + Enter ↵ to make a line break
press Enter ↵
5
Are you taking any regular medications (including over the counter or herbal medicines)? Do you have any other medical condition or previous operations not already mentioned?*
6
Please list all your medications you take and any other medical conditions or previous operations.
Shift ⇧ + Enter ↵ to make a line break
press Enter ↵
6
Please enter your gender
7
Are you pregnant or breastfeeding?*
7
Discretion is at the heart of what we do but for legal reasons the name on your prescription must be your full legal name. Please provide your legal name as per your official government ID. *
Shift ⇧ + Enter ↵ to make a line break
press Enter ↵
8
Please provide your date of birth *
/
/
press Enter ↵
9
Based on your medical history and individual needs, our doctors have provided personalised treatment. Please complete your mobile phone number to view recommended treatment. *
press Enter ↵
15
Do you have a Medicare card?
15
Please enter your Medicare Card details
/
press Enter ↵
14
Do you agree to use Burst Health's preferred pharmacy provider to ensure the fastest delivery time of your prescribed medication?
15
Do you have an NHI?
17
What is your NHI?
Shift ⇧ + Enter ↵ to make a line break
press Enter ↵
4
Do you have a medication preference?
5
Do you prefer
6
Please select your preferred strength
7
Have you taken 40mg before?
15
What is your IHI?
Your IHI is located next to your Covid vaccine certificate. If you are an international student or working visa holder, for our doctors to write a prescription, you first need to register for myGov and an IHI (Individual Health Identifier). You can do this all online within minutes. Please take a look at the Services Australia website for complete instructions, click here.
press Enter ↵
BOOKS CLOSED IN NEW ZEALAND
Due to overwhelming demand, we are not currently accepting new patients. For existing patients, please access your account here.Unfortunately you would not be suitable for our monthly treatment plan. Please book a consult with your local GP.
If you made a mistake, you can go back and correct your answer.
press Enter ↵
Unfortunately based your answer you would not be suitable for treatment.
If you made a mistake, you can go back and correct your answer.
press Enter ↵
Please follow this link to book a $85 consultation with our doctor:
Click here to book If you made a mistake, you can go back and correct your answer.
press Enter ↵
That date isn't valid. Check the month and day aren't reversed.
Please fill this in