PrEP 線上訂單
Email address *
英文姓名/ ENGLISH NAME  *
Your answer
中文姓名 (如有)/ CHINESE NAME (IF APPLICABLE)
Your answer
姓 / FAMILY NAME *
Your answer
身分證/ID NO OR RESIDENCY NO *
Your answer
生日 / BIRTH DAY & YEAR *
MM
/
DD
/
YYYY
電話號碼 / PHONE NUMBER (WITH COUNTRY CODE e.g. +886) *
Your answer
Line Account ID (可更快速付款或得到回復)
Your answer
Wechat Account ID (可更快速付款或得到回復)
Your answer
PrEP選擇 / SELECTION *
數量/QUANTITY *
運費+收件保險/ SHIPPING(如無法收件,全額退款) *
急件處理嗎?/ EXPRESS SHIPPING *
Required
郵寄地址 (請附上中英文地址) / SHIPPING ADDRESS *
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是否已經要求醫院或自己把處方/檢驗報告發送到service@preptaiwan.org? Has the prescription or blood test results been sent to service@preptaiwan.org? *
Required
請問您是如何認識此網站? (可選擇多個) / HOW DID YOU KNOW ABOUT OUR SITE? *
Required
備註 (非必要填寫) / OPTIONAL REMARKS
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享用優惠代碼 (請提供) / PROMO CODE(IF ANY)
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付款方法/ PAYMENT METHOD *
Required
上傳您的身份証前後照以便申報使用 (可候補) : http://bit.ly/preptaiwanID
付款同意需知: 收費為新加坡貨幣。如果指定醫生診斷后不批准開藥, 將全額退款。 所有其它退款申請, 將有本公司以個案批准和保留10%手續費為運作和支付平臺手續費。 本公司將保留所有退款安排決定權。
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