You can always press Enter⏎ to continue
Pharmacy Visits System
1
Security Code
*
This field is required.
Previous
Next
Submit
Press
Enter
2
المحافظة
*
This field is required.
العاصمة - شمال وغرب عمان
العاصمة - جنوب وشرق عمان
الشمال
الجنوب
البلقاء والأغوار الوسطى
(الشرق(الزرقاء
Previous
Next
Submit
Press
Enter
3
صيدليات شمال وغرب عمان
*
This field is required.
Previous
Next
Submit
Press
Enter
4
صيدليات جنوب وشرق عمان
*
This field is required.
Previous
Next
Submit
Press
Enter
5
:صيدليات محافظة الشمال
*
This field is required.
Previous
Next
Submit
Press
Enter
6
:صيدليات محافظة الجنوب
*
This field is required.
Previous
Next
Submit
Press
Enter
7
: صيدليات محافظة البلقاء والأغوارالوسطى
*
This field is required.
Previous
Next
Submit
Press
Enter
8
: (صيدليات محافظة الشرق (الزرقاء
*
This field is required.
Previous
Next
Submit
Press
Enter
9
Visit Type
*
This field is required.
Order (DON'T USE Return)
Return (DON'T USE ORDER)
Payment
Account Statement
Samples
Gift
Just Visit
Inventory count
Previous
Next
Submit
Press
Enter
10
Select Brand
Honix
BioActive
External
BT Pharma
Previous
Next
Submit
Press
Enter
11
Select Honix Products
Honix Family
Honix Ointment
Honix Lip balm
Honix Foot Care
Honix Deep Active
Honix Lotion
Previous
Next
Submit
Press
Enter
12
Select BioActive/BT Pharma Products
*
This field is required.
BioActive Family
BioActive Omega 3
BioActive Folic Acid
BioActive BioGene
BioActive Orthogen
BioActive BioGene Glow
BT Pharma Vitamin C Plus CAP
BT Pharma Vitamin C Plus 30 Sachets
Previous
Next
Submit
Press
Enter
13
Select External Products
*
This field is required.
Max OptiFresh BioPlus
Previous
Next
Submit
Press
Enter
14
Payment Type (Pre)
*
This field is required.
Credit
Cash
Check with order
Credit
Cash
Check with order
Previous
Next
Submit
Press
Enter
15
Honix Ointment
Honix 15 g \Order
Honix 15 g \Bonus
Honix 30 g \Order
Honix 30 g \Bonus
Honix 70 g \Order
Honix 70 g \Bonus
Previous
Next
Submit
Press
Enter
16
Honix Lip Balm 10 g
Honix Lip Balm 10 g \Order
Honix Lip Balm 10 g \Bonus
Previous
Next
Submit
Press
Enter
17
Honix Foot Care 70 g
Honix Foot Care 70 gm \Order
Honix Foot Care 70 gm \Bonus
Previous
Next
Submit
Press
Enter
18
Honix Deep Active 50 g
Honix Deep active 50 gm \Order
Honix Deep active 50 gm \Bonus
Previous
Next
Submit
Press
Enter
19
Honix Lotion 200 ml
Honix lotion 200 ml \Order
Honix lotion 200 ml \Bonus
Previous
Next
Submit
Press
Enter
20
BioActive BioGene
BioActive BioGene \Order
BioActive BioGene \Bonus
Previous
Next
Submit
Press
Enter
21
BioActive BioGene Glow
BioActive BioGene Glow \Order
BioActive BioGene Glow \Bonus
Previous
Next
Submit
Press
Enter
22
BioActive Omega 3 Plus
BioActive Omega 3 Plus 120ml / 1500 \Order
BioActive Omega 3 Plus 120ml / 1500 \Bonus
Previous
Next
Submit
Press
Enter
23
BioActive Folic Acid
Folic Acid Tablet 400 mcg 90' \Order
Folic Acid Tablet 400 mcg 90' \Bonus
Previous
Next
Submit
Press
Enter
24
Max OptiFresh BioPlus
Max OptiFresh BioPlus 10ml \Order
Max OptiFresh BioPlus 10ml \Bonus
Previous
Next
Submit
Press
Enter
25
BT Pharma Vitamin C Plus Cap
BT Pharma Vitamin C Plus Cap \Order
BT Pharma Vitamin C Plus Cap \Bonus
Previous
Next
Submit
Press
Enter
26
BT Pharma Vitamin C Plus 30 Sachets
BT Pharma Vitamin C Plus 30 Sachets \Order
BT Pharma Vitamin C Plus 30 Sachets \Bonus
Previous
Next
Submit
Press
Enter
27
Order Information
Requester
Phone Number
Previous
Next
Submit
Press
Enter
28
Delivery Date
-
Date
Year
Month
Day
Previous
Next
Submit
Press
Enter
29
Payment Type (Post)
*
This field is required.
Cash
Check
Cash
Check
Previous
Next
Submit
Press
Enter
30
القيمة / Value
*
This field is required.
JOD
Previous
Next
Submit
Press
Enter
31
رقم الوصل/السند
*
This field is required.
Previous
Next
Submit
Press
Enter
32
رقم الشيك
*
This field is required.
Previous
Next
Submit
Press
Enter
33
تاريخ الإستحقاق
*
This field is required.
-
Date
Year
Month
Day
Previous
Next
Submit
Press
Enter
34
Upload File
Previous
Next
Submit
Press
Enter
35
Samples
Honix 15 g samples
Honix 30 g samples
Honix 70 g samples
BioActive Omega 3 Plus 120ml / 1500 samples
BioActive BioGene samples
Max OptiFresh BioPlus samples
BioActive BioGene Glow samples
Folic Acid Tablet 400 mcg 90' samples
Previous
Next
Submit
Press
Enter
36
أدخل الكمبيات المطلوبة
Honix 15 g inventory
Honix 30 g inventory
Honix 70 g inventory
BioActive Omega 3 Plus 120ml / 1500 inventory
BioActive BioGene inventory
Max OptiFresh BioPlus inventory
BioActive BioGene Glow inventory
Folic Acid Tablet 400 mcg 90' inventory
Previous
Next
Submit
Press
Enter
37
Gifts
See through
Roll up
Poster
Agenda
PEN
Sweets Grade 1
Sweets Grade 2
Sweets Grade 3
Previous
Next
Submit
Press
Enter
38
Account Statement
*
This field is required.
YES
NO
Previous
Next
Submit
Press
Enter
39
Visit Note
Previous
Next
Submit
Press
Enter
40
Visit Rate
*
This field is required.
1
2
3
4
5
Previous
Next
Submit
Press
Enter
41
Upload File
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
41
See All
Go Back
Submit