Order Generic Propecia online

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Personal Details

Medical questions for PROPECIA

Do you suffer from any allergies ? *	Yes No
If yes state in box.

Do you suffer from hair loss ? *	Yes No
Do you have prostate cancer? *	Yes No
Have you ever been checked for prostate cancer? *	Yes No
Are you taking any other medication? *	Yes No
If yes state in box.

You must never let a female directly handle the tablets due to the hormonal content. ( I understand )	Yes
If there is a chance of pregnancy, a condom should be worn during intercourse as propecia can be concentrated in the semen. ( I understand )	Yes
Have you ordered from Love Pharmacy before?	Yes No

Your PROPECIA order

Please supply me with the following PROPECIA prescription: *

Please note that it is prohibited to accept returns of prescription medication. We therefore cannot accept returns or refunds.

Agreement

By submitting this application form:	AGREE
I certify that I am 18+ years of age
I take full responsibility of informing my Doctor of this medication.
I have read and understand the potential side-effects of Propecia.
I do not have a current prescription for Propecia from another source.
I certify that I am allowed by law to use the credit card used to place this order.
I accept full responsibility for my use of the supplied drugs.
I certify that I have answered all the questions truthfully.

Terms and Waiver of Liability

Do you agree to our Terms and Waiver of Liability? *
Please read our Waiver of Liability. conditions.

I agree

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Expiry Date *
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