1. I hereby authorize Medical Wellness Center and any of its physicians, employees, associates, and contractors to perform and undertake an online medical consultation and evaluation of me for a potential patient for The Big Three hair loss treatments which include Avodart or Propecia, low dose Oral Minoxidil and 2% Nizoral Shampoo for Male pattern hair loss. I hereby release Medical Wellness Center and all of its employees and contractors including physicians from any and all liability whatsoever associated or connected with my Big Three and/or use of Avodart/Propecia, oral Minoxidil and Nizoral Shampoo combination.

2. I understand that only topical minoxidil and Propecia are FDA-approved for hair loss. I further understand that although oral minoxidil is FDA-approved for high blood pressure, Avodart approved for BPH and Nizoral approved for dandruff, it is not approved for hair loss.  Therefore, I acknowledge that I am being prescribed the combination of low-dose oral minoxidil, Nizoral shampoo and possibly dutasteride “off-label” for male pattern hair loss.  In contrast to oral minoxidil dose of 10-40 mg daily for hypertension, low-dose oral minoxidil for hair loss is a maximum of 2.5mg daily. 

3.  I hereby state that I am an adult MALE age 18 or older, I am aware of any possible side effects of Avodart/Propecia, Minoxidil and Nizoral shampoo, and I hereby agree to answer truthfully all of the questions on my questionnaire.

4.  I understand that no doctor can guarantee that the Big Three, Avodart/Propecia, oral Minoxidil and Nizoral shampoo, even if prescribed, will provide the results I seek. I acknowledge that no guarantees have been made to me as to the results as there is no known medical treatment that gives 100% satisfaction to everyone, nor are there any guarantees against unfavorable results, risks or complications.

5.  I understand that although low dose oral minoxidil is not commonly associated with major side effects, I may suffer adverse effects from Minoxidil. Studies show that less than 5% of men have had to stop treatment because of side effects. Also, I understand that although no serious adverse reactions have been reported regarding dutasteride, finasteride or Nizoral shampoo, I may suffer adverse effects.  Side effects are very uncommon and do not affect most men.  Less than 5% of men on finasteride or dutasteride experience sexual side effects such as less desire for sex, decrease amount of semen etc.  These side effects disappeared in most men who continued to take dutasteride or finasteride, and completely went away in men when they stopped dutasteride or finasteride. I also understand that although no serious side adverse reactions have been reported to date with Nizoral shampoo, I may suffer adverse effects from Nizoral.  Side effects from Nizoral are very uncommon.  Most side effects are limited to local irritation, itching, burning sensation at the treated site, dry or greasy hair, or rarely discoloration of gray, colored or chemically treated hair.

6. The most common side effect occurring with oral minoxidil in about 15% of users is hypertrichosis, increased hair growth on face and body. Usually within one to six months after stopping treatment, this excess hair growth reverses. Another common temporary side effect is increases shedding in the first 4 -12 weeks of treatment.

7. The following are some of the systemic side effects which can occur in about 5.5% of patients on low dose oral minoxidil: light-headedness, low blood pressure, dizziness, palpitations, increased heart rate, fluid retention, ankle and leg swelling, swelling around eyes, headaches, rashes, itching and rarely pericarditis, breast tenderness and insomnia.

8. *** If you experience new or increased chest pain, shortness of breath, sudden changes to vision or hearing or very severe heartburn, seek immediate emergency medical care.

9.  I understand that although in general serious adverse reactions are rare, one may develop allergic reactions or rare unreported side effects. I acknowledge that there are no guarantees made to me as to favorable or unfavorable results.  I accept and fully understand the risks known and unknown and accept the risk of substantial and serious harm and or complication even to the loss of bodily functions and/or life itself from using oral and/or topical Minoxidil, dutasteride or finasteride and 2% Nizoral (ketoconazole) shampoo in combination or individually.

10.  I further acknowledge that if I am prescribed the Big Three combination of finasteride/dutasteride, low dose Oral Minoxidil, and Nizoral Shampoo by Medical Wellness Center, I have full knowledge that no physician, nurse or medical personnel can predict as whether I would or would not have any adverse effects since every individual has a unique biological/chemical make-up. I understand that all possible risks and/or complications do not need to be explained to me, nor do I consider this practical or even possible because risks and complications may occur that have never been recorded before. I hereby release Medical Wellness Center and any associated physicians from any and all liability whatsoever with any adverse effects I may suffer from my use of finasteride/dutasteride, Minoxidil, and Nizoral Shampoo.

11.  I am participating in this Medical Wellness Center Online Minoxidil Consultation at my own choice, at my own expense, and my own liability and assume all responsibility for my use of Minoxidil. I acknowledge and agree that I initiated this contact with Medical Wellness Center, and I agree that all online medical consultations and treatments will be deemed to have occurred in the state where the physician is physically located and licensed to practice medicine which may be in another state from my own.

12.  I fully understand that it is my responsibility to have routine physical examinations to ensure that I have no disease(s) which might make treatment with the Big Three (dutasteride/finasteride, oral minoxidil, and Nizoral shampoo) inappropriate for my condition. I further agree that I have consulted with my physician and/or pharmacist and hereby warrant that I do not have any conditions or I am not taking any medications that would make low dose oral Minoxidil, dutasateride or finasteride, or Nizoral shampoo contraindicated. Low dose oral Minoxidil is contraindicated in the following conditions: heart disease, arrhythmia, afib, liver disease, kidney disease, high blood pressure, orthostatic hypotension, history of stroke, peripheral edema, pulmonary hypertension with mitral stensosis, Porphyria and Pheochromocytoma. Dutasteride, finasteride, oral minoxidil and 2% Nizoral shampoo should NOT be taken or used by pregnant or breast feeding women or anyone under the age of 18.  Furthermore, pregnant or breast-feeding women or women wanting to get pregnant should NOT even touch dutasteride or finsteride pills. I further agree to immediately notify any doctor whose present care I am under that I have chosen to use the Big 3 finasteride or dutasteride, oral minoxidil, and Nizoral shampoo..

13.  I further understand that not answering truthfully to any of the medical consultation questions or falsifying information in order to obtain prescription medication is a violation of both State and Federal U.S. law. I hereby agree to answer all questions on medical consultation truthfully.

14.  I understand that if I have failed in any way to provide Medical Wellness Center with my complete and accurate medical history or if I fail to notify Medical Wellness Center of any changes in the future, then I can not hold Medical Wellness Center or its physicians responsible for any adverse effects I may suffer and I am solely responsible for any adverse effects I may suffer from taking or continuing to use low dose Oral Minoxidil, finasteride or dutasteride, and Nizoral shampoo or from participating in this program.

15. If after a review of my consultation questionnaire, a physician determines that The Big Three treatment is appropriate treatment, a three month prescription will be forwarded to my local, United States pharmacy (medication not included, purchase the medications for  your local, brick-and-mortar,United States pharmacy. Prescriptions cannot be filled at online pharmacies such as or Cost Plus or .Com version of a local pharmacy or any mail order, internet or Canadian pharmacy.)

16. I hereby waive a physical exam at this time and agree to continue to have routine medical examinations by my regular physicians.

17. Also, I agree that if approved the medication will be used only by the person for whom prescribed, and I will not give medication or prescription to another party. I also understand the contraindications and warnings regarding Dutasteride/Finasteride/Minoxidil/Nizoral in breast-feeding women and pregnant or potentially pregnant women.

18.  I have read the contraindications to the Big 3 Treatment which includes finasteride or dutasteride,  low dose oral minoxidil, and Nizoral shampoo treatment and understand the contraindications.  The Big Three is prescribed Online for MALES only for Male pattern baldness. Male pattern hair loss or androgenic hair thinning in women could be due to life-threatening underlying conditions and must be treated by a physician who has physical contact and examines the patient and rules out diseases. Contraindicated in anyone under 18 years of age.

19. I understand that Medical Wellness Center is unable to accept any requests for cancellations or refunds for any reason once submitted.  There are no refunds given even if one changes one’s mind for any reason, has a change in one’s medical condition or upon the advice of another physician no longer desires the drug. One does not have to fill the prescription or take the medication, but there are NO refunds for the online consultation service.

In order to be eligible for an online Physician consultation, you must agree to the “Waiver of Liability” above. By clicking “agree” means that: I have read and understand the above referenced Medical Wellness Center’s Waiver of Liability and authorize and accept the proposed terms and I declare that I understand the risks. I declare that I have answered all questions truthfully and accurately.  I understand that by “clicking I Agree” electronically constitutes the equivalent of my signature upon a binding agreement between Medical Wellness Center and myself.