pharmaceutical products reservation and contact form

Dear customer,

on this page you have the possibility to book pharmaceutical products, or just sent questions, reviews and wishes straightly to us.
Please note that, we don`t send pharmaceutical products. You can get the pharmaceutical products only inside the pharmacy.

Reservation: till 10.00 o`clock you get the pharmaceutical products ex 12.30 o`clock
                   till 13.00 o`clock you get the pharmaceutical products ex 16.00 o`clock

Please quote the number of items, the name of the article, the packaging size and the pharmaceutical form inside the note window.

We keep the pharmaceutical products ready till you fix them up.
For difficulties we are without engagement.
The input boxes with * had to be filled out.

Deutsche Version

 

forename*:
family name*:
street:
residence:
fon*:
fax:
E-Mail:
*notice:
 

 

 

Declaration about protection of data privacy:
I agree, That my personal data set according to §3 of the Bundesdatenschutzgesetzes are stored. This declaration of consent can be stoped at any time, by myself. My personal data are jused intimate, like the declaration about protection of data privacy predicate and not be handeld on third persons.