Buy Propecia Medication Online

In order to receive your Propecia medication we ask that you please
complete the following fast and easy ordering process:

Certification &
Warranty Of
Applicant


Consent to Medical Care

Important!

I have read both the Certification and Warranty of the Applicant and the
Consent to Medical Care and agree to both of them.

Shipping Address:
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Address 2:
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Phone:
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Billing Address:
The next section addresses the actual billing address where the credit card statement is mailed each month. Please enter the exact address of where the credit card statement is sent each month for payment. This address will be verified with the issuing credit card company prior to charging the credit card. The billing address must exactly match the address on file where the credit card statement is mailed each month, or the charges will not be approved. This represents just another security measure taken by 1st Propecia Prescription to prevent fraudulent charges.
Country:
Address 1:
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Address 2:
(i.e. apt, suite no.)
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Billing Information:
Payment Type:

Credit Card
Money Order, Western Union, Paypal (Leave Credit Card Fields Blank). The customer service associates will email clients with further instructions concerning these payment options.

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Expiration Date:
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CVV2:
(Card Verification Value)

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For your safety and security, individuals are now required to enter their credit card's verification number (CVV2 code). The verification number is a 3-digit number printed on the back of most credit cards, (the number appears after and to the right of your card number), please refer to the example. If using an American Express card the CVV2 code is a 4-digit number printed on the front of your card, please refer to the example. Please note: By providing the CVV2 code this helps to insure that the credit card is in the possession of the user helping to decrease fraudulent charges.

Medical History (Information provided below is protected by patient/physician privacy laws.
This and all the other information you have entered is encrypted and safe during
transmission over the Internet).

Required Personal Information:
Height (in inches):
 2.54cm = 1in
Weight (in lbs):
 1kg = 2.2lb
Date of Birth:
/ / (i.e. apt, suite no.)
Sex:
 Male  Female

Medical History:

Do you or any of your immediate family have a history of the following medical conditions? 

Blood disorders e.g. anemia, hemophilia, hemochromatosis, phlebitis, sickle cell anemia, thalassemia, thrombosis, hypercholesterolemia, etc.
  
Cancer e.g. brain, breast, bladder, colorectal, endometrial, leukemia, lung, lymphoma, multiple myeloma, ovarian, prostate, skin, testicular, etc.
  
Cardiovascular disease e.g. angina, arrhythmia, atrial fibrillation, claudication, congestive heart failure, valve disorder, heart attacks, high blood pressure, strokes, etc.
 
Endocrine disorder e.g. diabetes, goiter, hyperthyroidism, hypothyroidism, pheochromocytoma, thyroiditis, etc.
  
Eye disorders e.g. cataracts, glaucoma, retinal complications, etc.
  
Gastrointestinal disorder e.g. acid reflux, hiatal hernia, irritable bowel syndrome (Crohn's disease, ulcerative colitis), polyps, rectal bleeding, ulcers, etc.
  
Genitourinary disorder e.g. benign prostatic hyperplasia, cysts, endometriosis, pelvic inflammatory disease, etc.
  
Immune disorders e.g. Hashimoto's disease, eczema, HIV, Graves disease, Sjogrens syndrome, sarcoidosis, sclerodoma, etc.
  
Kidney (urinary tract) disorder e.g. bladder disorders, cystic disease, glomerular disease, nephrotic syndrome, renal failure, urinary tract complications, etc.
  
Liver disorder e.g. cirrhosis, Gilbert's syndrome, hepatitis, hemochromatosis, Wilson's disease, etc.  
Musculoskeletal e.g. arthritis, back/spine complications, fibromyalgia, gout, lyme disease, muscular dystrophy, myasthenia gravis, osteomalacia, osteoporosis, rickets, spinal cord injury, etc.  
Neurological disorder e.g. Alzheimer's disease, epilepsy, head injuries, headaches, Huntington's disease, multiple sclerosis, seizure, etc.  
Psychological disorder e.g. anxiety, attention deficit disorder, bipolar disorder, depression, obsessive compulsive disorder, panic disorder, post traumatic stress disorder, etc.  
Respiratory disorder e.g. allergic rhinitis, asthma, chronic bronchitis, emphysema, tuberculosis etc.  
Other e.g. acne, chemical dependency, menopause, nutritional disorder, obesity, pregnant/nursing, significant trauma, etc.  
Do you have a history of any of the medical conditions previously mentioned including Blood disorders, Cancer, Cardiovascular disease, Endocrine disorder, Eye disorders, Gastrointestinal disorder, Genitourinary disorder Immune disorders, Kidney (urinary tract) disorder, Liver disorder Musculoskeletal, Neurological disorder, Psychological disorder, Respiratory disorder, Other conditions (not mentioned)?
If yes, please explain. For example, duration of illness, any surgery or treatment (ten year history of  hypertension (high blood pressure), Atenolol 50mg one per day - well controlled with medications, Blood pressure 132/84):		 Yes
No
 
Do you have a history of any blood disorders e.g. sickle cell anemia, thalassemia, bleeding disorders, etc?
If yes please explain:		 Yes
No

Additional Medical:
Currently, are you taking any medications (this includes over-the-counter or nonprescription medication, herbal supplements, sports supplements, etc.) or are you allergic to any medications, supplements or food products?
If yes, please explain (medication, supplement including dosage and frequency or explain allergic reaction):
 Yes
No
 
Do you consume more than two servings of alcohol per day or use tobacco products?
If yes, please quantify type of product and usage:
 Yes
No
 
Do you currently follow a routine exercise program?
If yes, please quantify type and amount of exercise:
 Yes
No

Propecia Specific Questions:
Do you currently believe you are experiencing hair loss?
If yes, please explain:
 Yes
No
 
How old were you when you first noted any substantial hair loss?
Please explain:
 
 
Does your hair loss appear to be a gradual process or has it occurred suddenly?
Please explain:
 
 
Where are you noticing the majority of your hair loss e.g. vertex (top of your head), the anterior mid-scalp region, temporal areas, etc.?
Please explain:
 
 
Have you previously been treated for hair loss?
If yes, please explain:
 Yes
No
Propecia can affect a blood test called prostatic specific antigen (PSA) for the screening of prostate cancer. It is very important if you have a PSA test done, to inform your physician that you are taking Propecia. Do you agree to inform your physician that you are taking Propecia?
 
 Yes
No  

1mg Propecia Tablets

  30 - 1mg Tablets £59.00 + FREE Consultation + FREE shipping =
£59.00
  90 - 1mg Tablets £99.00 + FREE Consultation + FREE shipping =
£99.00

*1st Propecia Prescription already offers the cheapest Propecia prices.
However, individuals can now save an additional £1.00 - £1.50 per Propecia
pill by ordering a larger quantity of the Propecia hair loss treatment medicine.
Special Instructions :
Finally, please list any "special instructions" associated with your order.

Next, simply click on the following submit button and
we will promptly process your Propecia order: