Before You Proceed:

1. You must be 18 years of age or your parent must fill the form.
2. Fill every form as much as possible.
3. You should have your nearest pharmacy name, telephone and fax number at hand in-order for us to call in your prescription.
4. Please, be advised that anti-herpes medication reduces the recurrence and severity of the outbreak and does not CURE herpes.  Its effect is not 100% and NO GAURANTEE is made.
5. There is a consultation fee of $89 and your prescription will be called into the pharmacy of your choice.