Name *

First Name

Last Name

Delivery options

I will pick up my remedies from the clinic. PLEASE REFER TO YOUR INVOICE FOR CLINIC PICK UP TIMES

Mail remedies to me at my residential address

Payment method *

Pay via direct deposit using the bank details provided on the invoice and avoid bank surcharge

Call the clinic and provide my credit card details

My credit card details are stored on clinic file

Pay at the clinic when you pick up your remedies. Be aware of credit card surcharge.