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
Name of Customer *
Contact number *
Email address
Delivery address *
Medicine to be delivered
Frequency of delivery
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy