Treatment Checkout Confirmation HiddenSelect Hair Lost Type for Women Choice 1 Choice 2 Choice 3 Choice 4 Choice 5 Choice 6 Choice 7 Choice 8 HiddenWhat’s your gender? Male Female HiddenWhat’s your date of birth?Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920HiddenAre you trying to conceive, pregnant or breastfeeding? No Yes HiddenAre you taking any medications?? No Yes HiddenPlease list (including daily dose for any hair loss treatments)HiddenDo you have any medical or health issues? No Yes HiddenPlease listHiddenDo you have any allergies? No Yes HiddenPlease listOrder Sumary The Hairy Pill® for Women A$225 (3 months paid upfront) Product NameExpress Shipping FreeDiscount Code Total $ 0.00 From June 23rd 2023 you can pause, delay, and cancel.Create your accountYour mobile number* Email* * Enter Password Confirm Password Strength indicator Shipping details* First Name Last Name * Street Address Address Line 2 City StateAustralian Capital TerritoryNorthern TerritoryNew South WalesQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia State Postcode PaymentPayment Method* Credit Card Zip Pay Credit Card* MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiry Month010203040506070809101112 Expiry Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name
