Subscription-based Medicine home Delivery customers Form
If your near and dear one is patients of Diabetes, Thyroid, Hypertension (BP) , Neurological problem, psychiatric, pregnancy, Kidney disease, cancer and difficult in finding their medicine , Medilane Pharmacy is here to help you . WE PROVIDE SUBSCRIPTION BASED Medicine Home delivery in Manipur for you.
Please fill up the following form to avail this unique service.
Regards
Medilane Pharmacy Team
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Name of Customer
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Your answer
Contact number
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Your answer
Email address
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Delivery address
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Your answer
Medicine to be delivered
Your answer
Frequency of delivery
Every 7 days
Every 15 days
Every 30 days
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