Confirmation Form

Please fill out this form after you made a payment via Bank Transfer for your online purchase.

If you have any trouble filling out this form, you can also send your proof of payment to our email at with a title of “Confirmation of Payment”,

as well as to our Whatsapp number at +62811117886.


    Relactagel® is a lactic acid gel that is clinically proven to treat and prevent bacterial Vaginosis (BV).