To order Platinus

The difficult system of the preparation’s coding has been developed for protection against fakes. Each patient receives the identification number in which the personal data, date of issue and stages of treatments is specified. Receiving the preparation, be convinced of its authenticity.
For reception of identification number please fill-in the form.

* Patient’s name:
* Age:
* Weight:
* City (region):
* Phone:
* E-mail:
*Preparation:
* The diagnosis and its date :
* Whether did you have chemotherapy, how many times and when:
* An operation. If yes, when:
* Did you use hormonal preparations:
* Your condition now:
* Enter symbols from the picture