Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.About You - Step 1 of 2Name *FirstLastContact Number *Email * *MaleFemaleDate of birth *Please enter the country you are planning to travel to *What date are you travelling? *NextDo you agree to the following? *YesNoYou have answered all of the above questions accurately and truthfully. You understand our prescriber(s) will prescribe medication based on your responses and interactions with Twilight Pharmacy. Any incorrect responses or deliberate acts to misinform may be hazardous to your health. You agree to the terms and conditions, privacy policy, and terms of use. You will familiarize yourself with the patient information leaflet included with your order and any other information relayed to you via other means including IM/E-mail/telephone. You will contact us and inform your GP if you experience any side effects to treatment, if there are any changes to your medical history including starting any new medications or new diagnoses, or if your symptoms/medical conditions change in any way. You understand completing a purchase does not guarantee supply of treatment; the final decision to prescribe lies with the prescriber with your best interests, health, and appropriateness in mind. You agree to the terms and conditions, privacy policy, and terms of use.Submit
