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Order Van Tongelen

General Information

First name:

 *

Last name:

 *

Street - Nr:

Zip-code - State:

Phone number:

 *

E-mail:


Your order

Number

Product name

Dosering
(e.g. 500 mg)

Form (salve, suppo, pills,...)

Number
(50 comp.)

Do u
have a
prescription?
Add

More information

  • When you place the order before 1pm. you can come obtain it from 17u.
  • When you place the order before 5pm. you can come obtain it the next day in the morning.
I wish the confirmation of my pharmacist that all products are available:
Yes    No


Extra Comment:

Attachment

Here you can add documents (e.g. a scanned prescription)
(We accept only the following file formats: jpg, tif, pdf)
Add

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