Treatment Checkout Confirmation HiddenSelect Hair Lost Type for Men Choice 1 Choice 2 Choice 3 Choice 4 Choice 5 Choice 6 Choice 7 Choice 8 Choice 9 Choice 10 Choice 11 Choice 12 HiddenWhat’s your gender? Male Female HiddenWhat’s your date of birth?Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920HiddenAre 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 listHiddenhairgoalsReduce hair lossSimulate hair growthStrengthen hairIncrease hair healthAll of the aboveHiddentemp_user_id Hiddenutm_content Hiddenutm_source Hiddenutm_medium Hiddenutm_campaign Order Sumary The Hairy Pill® for Men 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 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date Security Code Cardholder Name
