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Personal Details

Your First Name :

Your Last Name :

Your Email :

Your Phone:

Your Zip Code:

Billing and Shipping Address

Street Address:




Health Questionnaires

Date of Birth: mm/dd/year

Your Height: ft-in

Your Weight: Lbs


1. I agree not to take any over-the-counter medicines without approval from my pharmacist.

If you disagree, please explain why:

2. I agree not to take medication if I am pregnant, breast-feeding, or trying to get pregnant.

If you disagree, please explain why:

3. Please list all current medical conditions including high blood pressure. Choose "None" if none.

Specify all current medical conditions:

4. Is there anything in your medical history that you consider to be relevant? If yes, please specify. Choose "None" if none.

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.

6. Please list all medications that you plan to take while on this program. Choose "None" if none.

7. Please list all past or present allergies including allergies to any medications. Choose "None" if none.

8. Please list all past surgeries and provide details including the condition that was treated with each surgery. Choose "None" if none.

9. Please explain the specific medical reason for ordering this medication. The physician must know the exact nature of your medical problem in order to prescribe this medication. This cannot be left blank.

I double checked the information and confirm all the information is correct , and I will pay you a money order when I pick up the drugs. I also know the order cannot be cancelled when I click "place order now" link

COD payment

We only accept COD (Collect On Delivery) Payment. Your billing Address and Shipping Address must be the same.

Free Shipping Fee

We provide USPS Priority Mail shipping to all orders. We provide free shipping and Free COD collecion to all orders. We will send you tracking ID and order ID together once the order is shipped.


We cannot refill your medications automatically. You have to come to our website fioricetdrug.com to refill your self. We may need up to seven days to deliver your orders to your doors.

Websites sometimes do not work properly. You can always refill by email to the email account that sent you order ID and tracking ID.

We never phone you to refill your orders. Never trust the guys phone you. They are typical spammers.

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The information contained on this site is general in nature and is not meant to substitute for the advice provided by your own physician or other healthcare professional. We do not warrant and shall have no liability for information provided in this site.


We are not healthcare professionals and, therefore, no information, advice or direction that we give you either on this site or by referring you to the supplier should be taken as medical or health advice, or even as an indication in our opinion that you are suitable to take any drug. ALWAYS seek the advice of a healthcare professional before taking any medication.