Finasteride

Fill out all the information(Obligatoriskt)

First name Last name

Social security number YYYYMMDD-XXXX(Obligatoriskt)

Do you have a foreign social security number?(Obligatoriskt)

Yes

Are you taking medication for prostate problems?(Obligatoriskt)

Yes

If yes, write down the name of the medication and the dosage.

Are you completely healthy?(Obligatoriskt)

Yes

If not, enter what diseases or issues you have

Is there anything else we should know about your health?(Obligatoriskt)

Yes

If yes, please tell us what

Comments

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