Prescriptions

We deliver on any prescriptio, given by a physician. Inform us about your wishes by filling in and sending the form below either online or by FAX. We will fulfill your wishes promptly!

Physician:
Name: City:
Country:
Prescribed remedy: (exact name!) International name of the active substance (foreign drugs only)
Patient:
Age: [Jahre] for Babys: [months]
Sex:  male   female Weight: [kg]
Treated Illness:
Collection
Presumed time of Collection date:
a.m.
p.m. 		Name of collector:
For a reply, enter your email-address or FAX-Number here:
Phone (05 31) 31 15 12
Fax (05 31) 31 23 53 		  eMail:
Rosen-Apotheke@t-online.de
For truckers Rosen-Apotheke Cyty-Brunswick
Imprint, http://bs.cyty.com/rosenapo/fernfahr/rzept-en.htm, Version: September, 18th 2001, jk