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Consultation Form -- Quantity Restriction Applies

As you are ordering a pharmacist-only/restricted medicine, you will be required to answer a few quick questions for us in compliance with pharmacy legal requirements for the purchase and sale of restricted medicines. All questions are related to the purchase of the pharmacist only medicine(s). Your answers will be reviewed by our pharmacist who will assess the safety and appropriateness of the product and if required, will be in contact with you.

Customer Declaration: By ordering I acknowledge that I have read and understand the information regarding the product and agree to use it solely for my personal use. I agree to use it strictly as directed and if symptoms persist or if I suffer any adverse effect I will contact my doctor or pharmacist immediately.