Male Patients Form 2

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Premature Ejaculation

Your Details

First Name *

Last Name *

Email *

Mobile *

Date of birth *

Sex *

Male

Female

Home Address *

County *

Country *

EirCode *

Pharmacy Name *

Pharmacy Location *

Pharmacy EirCode *

Medical Questions

Do you have any significant current or past medical conditions? *

Yes

Are you currently taking any medication? Please advise which ones. *

Yes

Are you allergic to any Medications? *

Yes

Are you currently breastfeeding *

Yes

Package Plans:

Basic: within 2-3 days 19.99 EUR

*Applications will be reviewed and if approved, a certificate signed by an Irish doctor will be sent via email within 2-3 days.

Standard: within 24 hours 24.99 EUR

*Applications will be reviewed and if approved, a certificate signed by an Irish doctor will be sent via email within 24 hours.

RECOMMENDED: within 12 hours 29.99 EUR

*Applications will be reviewed and if approved, a certificate signed by an Irish doctor will be sent via email within 12 hours.

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Male Patients Form 2

Premature Ejaculation

Your Details

Medical Questions

Medical Questions

Package Plans:

Get Medical Certificates Online

Get Online Prescription

Online Doctor Consultation

Get Started

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