Please print out and complete the following form.
These can be either faxed or posted to Menscare Services. 
Click on the button or press 'CTRL' + 'P'
By Fax: Print out the order form and fax it to 01889 562036, sending payment to:
Menscare UK LTD. 57 Balance Street, UTTOXETER, Staffordshire, ST14 8JQ
 Make your cheque or postal order payable to: Menscare UK LTD

By mail: Print out the order form and post it with your payment to:
Menscare UK LTD. 57 Balance Street, UTTOXETER, Staffordshire, ST14 8JQ
 Make your cheque or postal order payable to: Menscare UK LTD


Waiver of Liability

I hereby release Menscare Services and all of its employees and contractors including physicians from any and all liability whatsoever associated or connected with my Reductil Consultation and/or my use of Reductil. I hereby state that I am an adult and that I am aware of the potential side effects associated with Reductil. I hereby agree to answer truthfully all of the medical questions on my questionnaire.I understand that no doctor, nurse, or administrative personnel can guarantee that Reductil, even if prescribed, will provide the results I seek. Further, I understand that even if prescribed, I may suffer adverse effects from Reductil. I hereby release Menscare Services and all of its employees and contractors including physicians from any and all liability whatsoever associated with any adverse effects I may suffer from my use of Reductil.

I am submitting this questionnaire at my own choice, at my own expense, and my own liability and assume all responsibility for my use of Reductil. I fully understand that it is my responsibility to have an annual physical examination, including any suggested laboratory tests, to ensure that I have no disease which might make Reductil inappropriate for my condition. I further agree that I have consulted with my present physician and/or pharmacist and hereby warrant that I am not taking any medications or combination of medications that are on the published list of medications which would make Reductil contraindicated. I further agree to immediately notify any doctor whose present care I am under that I have chosen to take Reductil so that they may advise to continue or discontinue use. Should I engage a new doctor's care in the future, I further agree to immediately notify said doctor of my use of Reductil.

Name (please print)

Signature................................................

 

MEDICAL DECLARATION

Full Name and Title:
Date of Birth (dd/mm/year)  
Height
Weight
Delivery Address
Post code
   
Telephone
Fax


Do you suffer from any allergies ? Yes No
If yes state in box.  
Do you suffer from uncontrolled high blood pressure?
 Yes No
Have you or do you sufferer from anorexia or bulimia?
 Yes No
Do you suffer from liver, kidney, thyroid or prostate disorder? Yes No
Are you taking any Anti-Depressive medication?
 Yes No
If yes state in box.
Are you taking any other medication? Yes No
If yes state in box.
Have you ordered from Menscare Services before? Yes No

ORDER FORM

All prices shown on this website are inclusive and include special delivery charges
Please tick the quantity that you require:

Strengths

Amounts

Prices
10mg
1 Months Supply
£120.00 sterling
 
2 Months Supply
£235.00 sterling
 
3 Months Supply
£350.00 sterling
 
4 Months Supply
£460.00 sterling
 
28 tablets for a 1 month course
  
15mg
1 Months Supply
£130.00 sterling
 
2 Months Supply
£255.00 sterling
 
3 Months Supply
£370.00 sterling
 
4 Months Supply
£480.00 sterling

 

Payment Details
I enclose my cheque/cash/postal order for £
(Cheques payable to Menscare UK LTD)
Please charge my credit/debit card account £
Card No
Expiry Date
Issue No/Valid from date (If applicable)
Name on card  
Card Company (e.g, Visa, Mastercard etc)  

 

Signed.................................................................................

 

 

 

Price

Reductil £
Total amount due £

 

Click on the button or press 'CTRL' + 'P'

All Medicines dispatched from our UK Pharmacy
Guaranteed Next Day Delivery included

Menscare Services
Menscare UK LTD. 57 Balance Street, UTTOXETER, Staffordshire, ST14 8JQ
Telephone: 01889 569467 or 01889 569178 Fax: 01889 562036

Telephone : 01889 569467 or 01889 569178
Lines Open - Mon-Fri 8.30a.m to 5.30p.m
Email:admin@menscare.co.uk