ANAGEN.NET - ONLINE ORDER FORM DR KLEIN BY REGENERE HAIR GROWTH MD
 
 
The credit card will be charged and the ordered products will be shipped only if the doctor approves the consultation.
DETAILED PRODUCT INFORMATION PLEASE SELECT      
         
REMOX 5% SPRAY 1 bottle 60 ml $56 with DMI (free) no tretinoine (free)
(minoxidil 5% + tretinoine 0.025%) 3 bottles 60 ml $168 with DMI (free) no tretinoine (free)
  6 bottles 60 ml $336 with DMI (free) no tretinoine (free)
  10 flaconi da 60 ml $504 (circa 321 euro) con DMI (gratis) senza tretinoina (gratis)
         
  1 bottle 100 ml $86 with DMI (free) no tretinoine (free)
  3 bottles 100 ml $258 with DMI (free) no tretinoine (free)
  6 bottles 100 ml $516 with DMI (free) no tretinoine (free)
  10 flaconi da 100 ml $774 (circa 493 euro) con DMI (gratis) senza tretinoina (gratis)
         
REMOX 10% SPRAY 1 bottle 60 ml $66 with DMI (free) no tretinoine (free)
(minoxidil 10% + tretinoine 0.025%) 3 bottles 60 ml $198 with DMI (free) no tretinoine (free)
  6 bottles 60 ml $396 with DMI (free) no tretinoine (free)
  10 flaconi da 60 ml $594 (circa 378 euro) con DMI (gratis) senza tretinoina (gratis)
         
  1 bottle 100 ml $96 with DMI (free) no tretinoine (free)
  3 bottles 100 ml $288 with DMI (free) no tretinoine (free)
  6 bottles 100 ml $576 with DMI (free) no tretinoine (free)
  10 flaconi da 100 ml $864 (circa 550 euro) con DMI (gratis) senza tretinoina (gratis)
         
REMOX 5% FOAM 1 bottle 150 ml $72   no tretinoine (free)
(minoxidil 5% + tretinoine 0.025%) 3 bottles 150 ml $216   no tretinoine (free)
  6 bottles 150 ml $432   no tretinoine (free)
  10 flaconi da 150 ml $648 (circa 413 euro)   senza tretinoina (gratis)
         
REMOX II 12.5% LOTION 1 bottle 60 ml $72   no tretinoine (free)
(minoxidil 12.5%, tretinoine 0.025% + 3 bottles 60 ml $216   no tretinoine (free)
hydrocortisone 0.1%) 6 bottles 60 ml $432   no tretinoine (free)
  10 flaconi da 60 ml $648 (circa 413 euro)   senza tretinoina (gratis)
         
  1 bottle 100 ml $102   no tretinoine (free)
  3 bottles 100 ml $306   no tretinoine (free)
  6 bottles 60 ml $612   no tretinoine (free)
  10 flaconi da 60 ml $918 (circa 585 euro)   senza tretinoina (gratis)
         
REMOX III 5% SPRAY 1 bottle 60 ml $54 with DMI (free) no tretinoine (free)
(minoxidil 5%, tretinoine 0.025% + 3 bottles 60 ml $162 with DMI (free) no tretinoine (free)
azelaic acid 1.5%) 6 bottles 60 ml $324 with DMI (free) no tretinoine (free)
  10 flaconi da 60 ml $486 (circa 309 euro) con DMI (gratis) senza tretinoina (gratis)
         
  1 bottle 100 ml $84 with DMI (free) no tretinoine (free)
  3 bottles 100 ml $252 with DMI (free) no tretinoine (free)
  6 bottles 100 ml $504 with DMI (free) no tretinoine (free)
  10 flaconi da 100 ml $756 (circa 481 euro) con DMI (gratis) senza tretinoina (gratis)
         
REMOX III 10% SPRAY 1 bottle 60 ml $64 with DMI (free) no tretinoine (free)
(minoxidil 10%, tretinoine 0.025% + 3 bottles 60 ml $192 with DMI (free) no tretinoine (free)
azelaic acid 1.5%) 6 bottles 60 ml $384 with DMI (free) no tretinoine (free)
  10 flaconi da 60 ml $576 (circa 367 euro) con DMI (gratis) senza tretinoina (gratis)
         
  1 bottle 100 ml $94 with DMI (free) no tretinoine (free)
  3 bottles 100 ml $282 with DMI (free) no tretinoine (free)
  6 bottles 100 ml $564 with DMI (free) no tretinoine (free)
  10 flaconi da 100 ml $846 (circa 539 euro) con DMI (gratis) senza tretinoina (gratis)
         
REMOX III 10% LOTION 1 bottle 60 ml $73   no tretinoine (free)
(minoxidil 10%, tretinoine 0.025%, 3 bottles 60 ml $219   no tretinoine (free)
azelaic acid 1.5% + hydrocortisone 0.1%) 5 bottles 60 ml $365   no tretinoine (free)
  8 bottles 60 ml $584   no tretinoine (free)
  10 flaconi da 60 ml $657 (circa 418 euro)   senza tretinoina (gratis)
         
  1 bottle 100 ml $103   no tretinoine (free)
  3 bottles 100 ml $309   no tretinoine (free)
  5 bottles 100 ml $515   no tretinoine (free)
  8 bottles 100 ml $824   no tretinoine (free)
  10 flaconi da 100 ml $927 (circa 590 euro)   senza tretinoina (gratis)
         
REMOX III 15% LOTION 1 bottle 60 ml $83   no tretinoine (free)
(minoxidil 15%, tretinoine 0.025%, 3 bottles 60 ml $249   no tretinoine (free)
azelaic acid 1.5% + hydrocortisone 0.1%) 5 bottles 60 ml $415   no tretinoine (free)
  8 bottles 60 ml $664   no tretinoine (free)
  10 flaconi da 60 ml $747 (circa 476 euro)   senza tretinoina (gratis)
         
  1 bottle 100 ml $113   no tretinoine (free)
  3 bottles 100 ml $339   no tretinoine (free)
  5 bottles 100 ml $565   no tretinoine (free)
  8 bottles 100 ml $904   no tretinoine (free)
  10 flaconi da 100 ml $1017 (circa 648 euro)   senza tretinoina (gratis)
         
REMOX IV 5% SPRAY 1 bottle 60 ml $54 with DMI (free) no tretinoine (free)
(minoxidil 5%, tretinoine 0.025%, 3 bottles 60 ml $162 with DMI (free) no tretinoine (free)
azelaic acid 1.5% + progesterone 0.25%) 6 bottles 60 ml $324 with DMI (free) no tretinoine (free)
  10 flaconi da 60 ml $486 (circa 310 euro) con DMI (gratis) senza tretinoina (gratis)
         
  1 bottle 100 ml $84 with DMI (free) no tretinoine (free)
  3 bottles 100 ml $252 with DMI (free) no tretinoine (free)
  6 bottles 100 ml $504 with DMI (free) no tretinoine (free)
  10 flaconi da 100 ml $756 (circa 481 euro) con DMI (gratis) senza tretinoina (gratis)
         
REMOX IV 10% SPRAY 1 bottle 60 ml $64 with DMI (free) no tretinoine (free)
(minoxidil 10%, tretinoine 0.025%, 3 bottles 60 ml $192 with DMI (free) no tretinoine (free)
azelaic acid 1.5% + progesterone 0.25%) 6 bottles 60 ml $384 with DMI (free) no tretinoine (free)
  10 flaconi da 60 ml $576 (circa 367 euro) con DMI (gratis) senza tretinoina (gratis)
         
  1 bottle 100 ml $94 with DMI (free) no tretinoine (free)
  3 bottles 100 ml $282 with DMI (free) no tretinoine (free)
  6 bottles 100 ml $564 with DMI (free) no tretinoine (free)
  10 flaconi da 100 ml $846 (circa 539 euro) con DMI (gratis) senza tretinoina (gratis)
         
REMOX IV 10% LOTION 1 bottle 60 ml $69   no tretinoine (free)
(minoxidil 10%, tretinoine 0.025%, 3 bottles 60 ml $207   no tretinoine (free)
azelaic acid 1.5%, hydrocortisone 0.1% + 5 bottles 60 ml $345   no tretinoine (free)
progesterone 1.25%) 8 bottles 60 ml $552   no tretinoine (free)
  10 flaconi da 60 ml $621 (circa 395 euro)   senza tretinoina (gratis)
         
  1 bottle 100 ml $99   no tretinoine (free)
  3 bottles 100 ml $297   no tretinoine (free)
  5 bottles 100 ml $495   no tretinoine (free)
  8 bottles 100 ml $792   no tretinoine (free)
  10 flaconi da 100 ml $891 (circa 567 euro)   senza tretinoina (gratis)
         
REMOX IV 15% LOTION 1 bottle 60 ml $79   no tretinoine (free)
(minoxidil 15%, tretinoine 0.025%, 3 bottles 60 ml $237   no tretinoine (free)
azelaic acid 1.5%, hydrocortisone 0.1% + 5 bottles 60 ml $395   no tretinoine (free)
progesterone 1.25%) 8 bottles 60 ml $632   no tretinoine (free)
  10 flaconi da 60 ml $711 (circa 453 euro)   senza tretinoina (gratis)
         
  1 bottle 100 ml $109   no tretinoine (free)
  3 bottles 100 ml $327   no tretinoine (free)
  5 bottles 100 ml $545   no tretinoine (free)
  8 bottles 100 ml $872   no tretinoine (free)
  10 flaconi da 100 ml $981 (circa 625 euro)   senza tretinoina (gratis)
         
REMOX FOR WOMEN 3% SPRAY 1 bottle 60 ml $45 with DMI (free) no tretinoine (free)
(minoxidil 3% + tretinoine 0.025%) 3 bottles 60 ml $135 with DMI (free) no tretinoine (free)
  6 bottles 60 ml $270 with DMI (free) no tretinoine (free)
  10 flaconi da 60 ml $405 (circa 258 euro) con DMI (gratis) senza tretinoina (gratis)
         
  1 bottle 100 ml $75 with DMI (free) no tretinoine (free)
  3 bottles 100 ml $225 with DMI (free) no tretinoine (free)
  6 bottles 100 ml $450 with DMI (free) no tretinoine (free)
  10 flaconi da 100 ml $675 (circa 430 euro) con DMI (gratis) senza tretinoina (gratis)
         
REMOX FOR WOMEN 5% SPRAY 1 bottle 60 ml $55 with DMI (free) no tretinoine (free)
(minoxidil 5% + tretinoine 0.025%) 3 bottles 60 ml $165 with DMI (free) no tretinoine (free)
  6 bottles 60 ml $330 with DMI (free) no tretinoine (free)
  10 flaconi da 60 ml $495 (circa 315 euro) con DMI (gratis) senza tretinoina (gratis)
         
  1 bottle 100 ml $85 with DMI (free) no tretinoine (free)
  3 bottles 100 ml $255 with DMI (free) no tretinoine (free)
  6 bottles 100 ml $510 with DMI (free) no tretinoine (free)
  10 flaconi da 100 ml $765 (circa 487 euro) con DMI (gratis) senza tretinoina (gratis)
         
PROMOX 5% SPRAY 1 bottle 60 ml $62 with DMI (free) no tretinoine (free)
(minoxidil 5%, tretinoine 0.025%, 3 bottles 60 ml $186 with DMI (free) no tretinoine (free)
azelaic acid 1.5%, progesterone 0.25% + 6 bottles 60 ml $372 with DMI (free) no tretinoine (free)
finasteride 0.1%) 10 flaconi da 60 ml $558 (circa 355 euro) con DMI (gratis) senza tretinoina (gratis)
         
  1 bottle 100 ml $92 with DMI (free) no tretinoine (free)
  3 bottles 100 ml $276 with DMI (free) no tretinoine (free)
  6 bottles 100 ml $552 with DMI (free) no tretinoine (free)
  10 flaconi da 100 ml $828 (circa 527 euro) con DMI (gratis) senza tretinoina (gratis)
         
PROMOX 10% SPRAY 1 bottle 60 ml $73 with DMI (free) no tretinoine (free)
(minoxidil 10%, tretinoine 0.025%, 3 bottles 60 ml $219 with DMI (free) no tretinoine (free)
azelaic acid 1.5%, progesterone 0.25% + 6 bottles 60 ml $438 with DMI (free) no tretinoine (free)
finasteride 0.1%) 10 flaconi da 60 ml $657 (circa 418 euro) con DMI (gratis) senza tretinoina (gratis)
         
  1 bottle 100 ml $103 with DMI (free) no tretinoine (free)
  3 bottles 100 ml $309 with DMI (free) no tretinoine (free)
  6 bottles 100 ml $618 with DMI (free) no tretinoine (free)
  10 flaconi da 100 ml $927 (circa 590 euro) con DMI (gratis) senza tretinoina (gratis)
         
PROMOX 5% LOTION 1 bottle 60 ml $72   no tretinoine (free)
(minoxidil 5%, tretinoine 0.025%, 3 bottles 60 ml $216   no tretinoine (free)
azelaic acid 1.5%, progesterone 0.25%, 6 bottles 60 ml $432   no tretinoine (free)
finasteride 0.1% + hydrocortisone 0.1%) 10 flaconi da 60 ml $648 (circa 413 euro)   senza tretinoina (gratis)
         
  1 bottle 100 ml $102   no tretinoine (free)
  3 bottles 100 ml $306   no tretinoine (free)
  6 bottles 100 ml $612   no tretinoine (free)
  10 flaconi da 60 ml $918 (circa 585 euro)   senza tretinoina (gratis)
         
PROMOX 10% LOTION 1 bottle 60 ml $82   no tretinoine (free)
(minoxidil 10%, tretinoine 0.025%, 3 bottles 60 ml $246   no tretinoine (free)
azelaic acid 1.5%, progesterone 0.25%, 6 bottles 60 ml $492   no tretinoine (free)
finasteride 0.1% + hydrocortisone 0.1%) 10 flaconi da 60 ml $738 (circa 470 euro)   senza tretinoina (gratis)
         
  1 bottle 100 ml $112   no tretinoine (free)
  3 bottles 100 ml $336   no tretinoine (free)
  6 bottles 100 ml $672   no tretinoine (free)
  10 flaconi da 60 ml $1008 (circa 642 euro)   senza tretinoina (gratis)
         
PROMOX 15% LOTION 1 bottle 60 ml $89   no tretinoine (free)
(minoxidil 15%, tretinoine 0.025%, 3 bottles 60 ml $267   no tretinoine (free)
azelaic acid 1.5%, progesterone 0.25%, 6 bottles 60 ml $534   no tretinoine (free)
finasteride 0.1% + hydrocortisone 0.1%) 10 flaconi da 60 ml $801 (circa 510 euro)   senza tretinoina (gratis)
         
  1 bottle 100 ml $119   no tretinoine (free)
  3 bottles 100 ml $357   no tretinoine (free)
  6 bottles 100 ml $714   no tretinoine (free)
  10 flaconi da 60 ml $1071 (circa 682 euro)   senza tretinoina (gratis)
         
PROMOX 5% FOAM 1 bottle 150 ml $81   no tretinoine (free)
(minoxidil 5%, tretinoine 0.025%, 4 bottles 150 ml $324   no tretinoine (free)
azelaic acid 1.5%, finasteride 0.1%) 7 bottles 150 ml $567   no tretinoine (free)
  10 flaconi da 60 ml $729 (circa 464 euro)   senza tretinoina (gratis)
         
         
REMOX VOLUMIZING SHAMPOO bottle 150ml $25  
          

All patients or customers agree to the following :

I agree to provide my complete medical history to Medical doctor provided by Regenere and have a private consultation prior to beginning treatment.
I agree to contact the Doctor to discuss my diagnosis and medical history as submitted by my physician. I agree to maintain open communication with the doctor regarding my hair loss and any medical issues I may have.
I agree to contact the doctor throughout my treatment with any questions or concerns.
I understand that there is no one treatment that works for every person and there is no guarantee what kind of results I may expect from the treatment.
I understand no products will be dispensed, processed or shipped  without a proper consultation with the doctor provided by Regenere Products Inc.
I understand that my order may be cancelled and refunded if after the consultation if the doctor considers that I am not a good candidate for the treatment.

If you are not satisfied in any way with this product, you will receive your money back (25% restocking fee may apply).
 
PATIENT INTAKE FORM - PLEASE FILL PROPERLY (* required field)
 
FIRST NAME *
LAST NAME *
GENDER * MF  
DAY OF BIRTH *
MONTH OF BIRTH *
YEAR OF BIRTH *
TELEPHONE *
COUNTRY *
HOW LONG HAS YOUR HAIR BEEN THINNING? YEARS/MONTHS *  
WHERE IS YOUR HAIR THINNING? PART OF SCALP *
COMMENTS
WHAT MEDICATIONS, IF ANY, ARE YOU TAKING?
HOW TAKEN ?
ARE YOU ALLERGIC TO PROPYLENE GLYCOL?  
ALLERGIES
ARE YOU TAKING TESTOSTERONE ? *
DO YOU HAVE ANY OF THESE CONDITIONS ? *ENLARGED PROSTATE DIABETES HIGH BLOOD PRESSURE PROSTATE CANCER

BY TYPING YOUR NAME INE THE BOX BELOW, YOU ACKNOWLEDGE THAT THE INFORMATION PROVIDED IS TRUE - SIGNATURE *

SHIPPING DATA

(* required field)

PLEASE FILL PROPERLY

First and Last Name *

E-Mail Address *

Street and Number *

City *

State / Province *

Postal Code / ZIP *

Country *

 Free shipping in USA or $49 DHL other

Telephone Number *

Comments or additional information for the delivery
 

CREDIT CARD INFORMATION (required fields)

 

Other Credit Card
Card Holder's Name

Credit Card Number
Please carefully enter the 15 or 16 digit credit card
Expiration Date
 Month Year

Credit Card does not expire 

Security Code (CVV or Card Id)
(on the back of your credit card is 3 digits or 4 digits if American Express)  Where is my Card Id ?
Please enter the correct security code

Card Holder Address (if different from shipping data)
 
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Please click Send Order once only and wait for the response page.