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Direct Response Marketing (Jersey) Limited, jersey, channel islands. Mail Order Online Pharmacy.
Viagra, Propecia, Cialis, Uprima, Xenical, Avodart, Regaine (Minoxidil). Treatments for impotence, hair loss and weight loss.  
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 All major Credit Cards accepted
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SAME DAY DESPATCH FROM OUR BRITISH PHARMACY BEFORE 1PM (NOT INCLUDING HOLIDAYS/WEEKENDS)
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This is a secure online order form that uses server encryption to protect your personal data.

HAIRLOSS TREATMENTS REQUEST FORM

Our Doctor will review your Medical Declaration and will write your prescription based on your requirements.

    PLEASE NOTE - treatments may not be combined. Please read and understand all information before use (Regaine may be used in combination with either PROPECIA or AVODART)

    All prices on this secure form include a 15 prescription fee (where applicable) and 4.95 p&p. There is no charge if our doctor does not approve your order.

    I have previously used, or would like to be considered for the following product(s);

    PLEASE SELECT QUANTITY OF TREATMENT;


      PROPECIA (Finasteride)  
      PLEASE SELECT;

      AINDEEM (Finasteride)  
      PLEASE SELECT;

      AVODART 
      PLEASE SELECT;

      REGAINE 5% SOLUTION 
      PLEASE SELECT;

       

        PLEASE SELECT POSTAGE;

      Product Information - PROPECIA | AVODART | REGAINE/MINOXIDIL

      ALL PRICES ARE IN U.K POUNDS STERLING (£)

    Goods are despatched tax-free in the EU, but DRM cannot be responsible for local taxes or import restrictions which may apply in other countries.

Fields in RED and marked * are mandatory and MUST be completed.
PLEASE NOTE that this form must contain the details of the person who will be using the treatment.
    I confirm that I have read and understood the information given and that the information I supplied is the truth to my certain knowledge. I know of no reason why I should not be prescribed this product and I take full responsibility for my use of the product as recommended by the manufacturers. I believe that this consultation by the DRM appointed doctor is in my best interest as a patient and I consent to my medical and payment data being processed by DRM and being made available to the DRM appointed Doctor(s) and/or Pharmacy. I have read and understood the product information given regarding the use of this product by both DRM and the manufacturer, and I will read the packaging and enclosed leaflet before use.
    I confirm that none of my medical details, including any conditions and or medications have changed since my previous order.

    Full Name;-*
    By typing your name here you confirm your acceptance of the above statements.
    Your Date of Birth.
      *
      Post Code
      *
    **If You have changed address since your last order, please complete all of these fields;
      Despatch Address
      Please complete the first line of your delivery address (House name or Number or flat Number).
      If your credit card billing address is different, please enter this below.
      * House Name or number
      Town/City
      Post Code/ZIP
      Country

    PLEASE NOTE - Inclusion on this list does not indicate that we are able to ship to all countries - please enquire
      Credit Card Billing Address
      (if different to your despatch address)

      House Name or number
      Town/City
      Post Code/ZIP
      Fax Number
      Daytime Telephone Number

    **Please confirm your credit card details;
      Please debit my credit card.

      *
      Please enter 'XXXX' if any field is left blank after entering your number
      We accept most Credit Cards (except American Express).
    Card Type*
    Start Date
    Expiry Date*
      Switch issue number (if applicable)
      Credit Card Security ID number (This is now mandatory):
      *
      Please note that in an effort to reduce fraud and to safeguard the customer it is now necessary to supply the Security ID for Credit Card transactions. If your card does not have a Security ID or you are unable to read it, please contact us. Click the link below for an image of the location of the Security ID on your card.
      Visa/Mastercard - Security ID is printed on the signature strip on the back of the card.
      Name (as it appears on card)
      *

        discount code or coupon code:

      Please acknowledge;-
      I am aware that my order will be charged in £ (GB Pounds sterling) and that if I am ordering from outside the UK then the exchange rate will be determined on the day of transaction by my credit card company.

      *

      Please enter your name and email address here, so that we can contact you.
      Our doctor requires that we send you an email following receipt of your order to follow up on any potential issues. Entering your email address here, signifies your consent to this.

      Name *

      Email *

      e.g. 'name@domain.com'

    Please check that you have answered ALL the questions AND HAVE SELECTED THE CORRECT PRODUCT.

    The order may take a few moments to process.
    Please press the button below only once and wait for the acknowledgement page. Thanks.

    PLEASE NOTE; - UK law forbids the pharmacy from accepting back any prescribed medications once despatched.
    Once your order is placed we may not be able to cancel or change it.
    If you made a mistake when ordering, please contact us immediately preferably by phone or email.


    This is a secure online order form that uses server encryption to protect your personal data.


    propecia sales
    Concerned about ordering online?

    Read our Privacy Statement and Customer Guarantee


    ALL PRICES ARE IN U.K POUNDS STERLING (£)

    The price includes;- your consultation fee !
    OTHER CURRENCIES? -- orders will be applied to your credit card in U.K. Pounds, the amount will automatically be debited in your own currency, at the rate prevailing on the day of transaction by the credit card company.

      Goods are despatched tax-free in the EU, but DRM cannot be responsible for local taxes or import restrictions which may apply in other countries.

      Your order will normally be despatched on the day of your order if we received it before 1P.M (not weekends or holidays). Orders to the UK should arrive within 48 hours. Please allow 7 working days to Europe, 15 working days to OTHER COUNTRIES.

      YOUR GUARANTEE! - If your goods do not arrive for any reason, DRM will re-ship or refund your order!

    Direct Response Marketing (Jersey) Limited.

    Suite 15 Burlington House, St Saviours Road, St Helier, Jersey, British Channel Islands. JE2 4LA
    Telephone; 0845 121 6667 (UK local rate)
    Fax; 0845 121 6669 (UK local rate)
    International Telephone (44) 1534 510271

    General Enquiries - email: Email DRM: Order Enquiries - email: Email order dept
    All trademarks are acknowledged as the property of their respective owners.

    DRMORDER.JE