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Contact Form / Prescription Submission

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Important: Please make sure that the signature in the top left of the back of the prescription is clearly visible.

Please upload both the front and back of your prescription here, even if the back (apart from the signature) is blank.

Example:

Example of a prescription with a note about the signature on the back.

Supports images and PDF.

Please also upload even if the back is blank (for the signature).

Optional: If available, upload your prescription here. Alternatively, you can submit it later. Note: A prescription is also possible for age-related hair loss or thinning hair. Feel free to contact us if you have any questions.

Tip: Feel free to upload photos from different angles (front, top, side).

Confirmation

Note: By submitting this form, a customer account will be created automatically. Processing is carried out in accordance with Art. 6 para. 1 lit. b GDPR (contract fulfilment).