№ files_lp_4_process_1_37493
Regular Medication
Note: Date of decision to refer
DOB: dd/mm/yyyy
Sex assigned at birth: Male/ Female
Gender Identity (if different from that above): e.g. Male (inc trans man) / Female (inc trans woman) / Non-binary
Interpreter required: YES/NO
Disability: YES/NO- mobility/sensory/cognitive
Transport required: YES/NO
Mandatory Information: Urine Dip, Bloods, Prostate Exam
Taking dutasteride/ finasteride: YES/NO
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

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