Please select who you are
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Please select who you are
Patient / Consumer
Friend / family
Physician / Pharmacist
Orchidia Member
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Please Enter mobile no.
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Select Your Country
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Afghanistan
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Select Your Governorate
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Select Your Governorate
Product Name
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Product Name
Acanthaprop
Alphabrinzima
Alphanova
Alphanova Plus
Atropine Sulphate1%
Avazir Eye drop
Avazir Ointment
Bromoflam
Benoxidia
Co-avazir Eye drop
Co-avazir Ointment
Compichlor
Conjyclear
Conjyclear Fort
Cornetears Gel
Diflustero
Duoeffectum
Efemyo
Fortymox
Fortymox plus
Ganvir Gel
Gatyxel
Gatistar 0.5%
Glucoguard
Ioprost
Natamycin
Nevxal
Nevxal forte
Ocuguard
Ofusidic
Orchabepost
Orchacin 0.3%
Orchadexoline
Orchapred gel
Orchapred suspension
Orchatears Plus
Orchazid
Orchazid SDU
Orchinohist
Ozolamide
Orchireva
Pentolegic
Perfect Care
Perfect eyelids
Polyfresh
Polyfresh SDU
Polyfresh Extra SDU
Sodium chloride 5%
Solofresh
Taflupro SDU
Taflupro Plus SDU
Travonorm
Travonorm plus
Tears Guard
Timogel
Timxal
Trillerg
Twinzol
Twinzol SDU
Lenzy
Integrado anti-hair loss shampoo
Integrado hair growth lotion
Integrado anti-hair loss cream
Integrado anti-hair loss conditioner
Clarimond whitening facial wash
Clarimond whitening night serum
Clarimond whitening day cream
Clarimond whitening eye contour serum
Cute-guard anti-dandruff shampoo
Rosalinda oro moisturizing cream
Sensajoy acne facial wash
Sensajoy acne cream
Bio-Solari Lotion
Bio-Solari Cream
Bio-Solari Tinted
Bio-Solari Emulsion
Bio-Solari Kids
Lipoferric Folic
Calcisome D
Polyfresh Advanced
Integrado Extra hair lotion
Formamy Tablets
Methyl Folate H.G.C
Loteranol Comp
Loteranol Gel
Loteranol Ointment
Ioprost SDU
Azithrochidia 1%
Hydraboost Gel
Ocubesiflox
Orchamdryal SDU
Youth-Elixir Hyaluronic Acid Facial Serum
Unicyclomide
Gatyxel Ointment
When did the patient first experience symptoms?
When did the patient last experience symptoms?
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When did you start the medicine?
When did you stop the medicine?
Diagnosis/ Conditions
Product batch no.
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Dosage
Symptoms
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Patient Name (first & last)
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Date of birth (Patient)
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Mobile no.
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Doctor or prescriber contact details
Concomitant drug(s)
Other relevant history
Please select the Gender
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Please select the Gender
Male
Female
Pregnant?
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Yes
No
Did the symptoms result in
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Medical / surgical intervention
Hospitalization
None
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