digital prescription

If you have your recipe digitally available (for example by taking a photo of it with your phone), you can already send it to us via this form. Furthermore, we ask you a number of medical questions that we need to be able to perform responsible medication monitoring. After completing this form you will receive a confirmation by e-mail with your MED code and your order number. You will need both codes for ordering the prescription products (see also an example of an email with your MED code and order number). Do you still send us your original recipe?

  If the form doesn't show up, use the following link.
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