Jet Lag

Is there a three hour or more time gap between your home and your destination?
Do you require assistance?

Yes

No

Are you currently receiving any treatment or under any medication?
Please provide more information of the medication being used if any.

Yes

No

If female or transmale, are you currently pregnant, breastfeeding or planning to do so?
Please select your option

Presently Pregnant

Presently Breastfeeding

Planning on getting pregnant

Neither Pregnant nor Breastfeeding

What is your biological gender?
Please select your option

Male

Female

Transmale (Born a female)

Transfemale (Born a male)

Can you relate to any of the following?
You have an underlying medical condition
You've been through a major surgical procedure
You have allergic reactions
You have cardiovascular conditions or might have had suffered a stroke
You suffer from a low liver or kidney function

Yes

No

Can you relate to any of the following?

Your hair loss started recently, and you've lost a lot of hair in less than four weeks.

Hair loss has occurred in irregular spots on your head.

Your scalp is itchy or inflamed.

You've lost your hair as a result of your pharmacological treatment.

You're completely bald or have lost all of your body hair.

Yes

No

Did you know that?
If your condition does not improve after four weeks, you should consult a doctor.
You must not use Enstilar on broken skin or beneath a bandage.
You cannot use Enstilar aound the eyes or on the eyelids.

Yes

No

Have you been examined with any auto immune disease before?
It could be Crohn's disease, Ulcerative Colitis, Lupus, Rheumatoid Arthritis, among others

Yes

No

Are you on any of the following medications?
Fluvoxamine
Benzodiazepines
Antidepressants of any kind
Any sleep-inducing medication
Do you require assistance?

Yes

No

Do you have a history of using Melatonin?
If so, how successful was it?

Yes

No

We require additional information during the COVID-19 epidemic in order to execute your transaction in a timely manner.
Could you please tell us the reason for your trip?
For which duration will you be on the road?
Are your flights already booked?

Can we share this information with your General practitioner?
Providing us with your physician's address means that you allow us to share this information with him/her for updated medical records if need be. It also allows our clinician to access your medical records if there is a need for that. We advice you share this treatment with your doctor for him/her to update your medical records.

Yes

No

About our Pharmacy

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