Order Generic Reductil

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Personal Details

Medical questions for REDUCTIL

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

Do you, or have you ever had cardiovascular problems ? * E.g heart attack, angina or stroke	Yes No
Do you suffer from uncontrolled high blood pressure? *	Yes No
Have you or do you sufferer from anorexia or bulimia ? *	Yes No
Do you suffer from liver, kidney, thyroid or prostate disorder? *	Yes No
Are you taking any Anti-Depressive medication? *	Yes No

If yes state in box.

Are you taking any other medication? *

Yes No

If yes state in box.

Have you ordered from Love Pharmacy before?

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Your REDUCTIL order

Please supply me with the following REDUCTIL 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 Reductil.
I do not have a current prescription for Reductil 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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Payment information

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Expiry Date *
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Issue No:	if using Switch or Solo
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