避孕药品申请表
在医生审阅问卷及批准处方后,我们的工作人员会以邮件方式通知您付费。本表格在平常情况下
可以替代医生电话或视频就诊。一次可购买6个月的量。
You will be contacted via email regarding payment details once our doctors have approved yourprescription application. Usually, doctors will make decisions about your application according to the information provided in the questionnaire.

我们现在只可以服务BC 和ON, 如果您住在温哥华的其他省市请联系客服，我们会帮助您寻找当地医生。
Currently our services can only be used in the provinces AB, BC and ON. If you are from another province, please contact us so we can liaise you with a local physician.
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Email *
名字   Full name *
性别 Your Gender *
出于对荷尔蒙治疗的诊断的需要，我们需要您的性别信息 We need your gender information for hormonal purposes
你的手机号码  Your cell phone number *
加拿大卑诗省药剂师管理局和医师管理局（CPBC, CPSBC） 严格要求本网站收集完整的病人信息。首次购药填写，需15分钟，仅需每年更新一次及必要时更新 。                                                                                                                  According to the requirements of CPBC and CPSBC, our website need collect all necessary information of the patient. It will take only 15 minutes to fill the questionnaire for the first time.You only need to update the questionnaire one time per year and when necessary.
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