Call Toll Free
1-866-355-6337
HOME
FAQ
About
Contact
menu
Order Page
Your Order
Cialis (Tadalafil) 17.5mg Troches ,
17.5mg × 30 Troches
$145.00
Select Shipping Type
USPS Priority Mail (Free)
Total: $
145.00
Billing Information
First Name
*
Last Name
*
Address
*
City
*
State
*
Zip/Postal Code
*
Country
*
United States
Phone
*
Email
*
Cell-Phone
*
Shipping Information
My Shipping Info
Same As My Billing Info
Different from Billing
First Name
*
Last Name
*
Address
*
City
*
State
*
Zip/Postal Code
*
Country
*
United States
Phone
*
Payment Info
Credit Card
E-Checks
Card Type
*
Visa
MasterCard
American Express
Name On Card
*
Card Number
*
Expiration Date
*
01
02
03
04
05
06
07
08
09
10
11
12
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
CVV2
*
What is CVV2?
Bank Name
*
Routing Number
*
Account Number
*
Medical Questionnaire
Your Gender
MALE
FEMALE
Date of Birth
*
Month
01
02
03
04
05
06
07
08
09
10
11
12
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
Height (Feet/Inch)
*
Weight Lbs
*
1. I agree not to take any over-the-counter medicines without approval from my pharmacist
Do you Agree?
---
I Agree
I Disagree
Disagree? Explain why
2. Agree not to take medication if I am pregnant, breast-feeding, or trying to get pregnant.
Do you Agree?
---
I Agree
I Disagree
Disagree? Explain why
3. Please list all current medical conditions including high blood pressure. Choose "None" if none.
Do you Agree?
---
None
I will specify
Medical condition
4. Is there anything in your medical history that you consider to be relevant? If yes, please specify. Choose "None" if none.
Specify
---
None
I will specify
Medical History
5. Please list all over-the-counter and prescription medications that you are currently taking and the length of time for each.Choose "None" if none.
---
None
I will specify
6. Please list all medications that you plan to take while on this program. Choose "None" if none.
---
None
I will specify
7. Please list all past or present allergies including allergies to any medications. Choose "None" if none.
---
None
I will specify
8. Please list all past surgeries and provide details including the condition that was treated with each surgery. Choose "None" if none.
---
None
I will specify
9. Please explain the specific medical reason for ordering this medication. The physician must know the exact nature of your medicalproblem in order to prescribe this medication. This cannot be left blank.
I have read and understand the
Terms of Service
.
I have read and understand the
Privacy Policy
.