COMPOUND ORDERING Your Name (required)* First Last Do you have any allergies or sensitivities? (required)* Yes No Please briefly listNoneStreet Address* Street Address Address Line 2 Suburb State Post Code Preferred main contact number (required)*Secondary contact numberEmail address (required)**Please note, @yahoo.com and @yahoo.com.au email address are incompatible with this system and will not be received by the pharmacy. Please use a different account or call the store to ensure your order is received. Enter Email Confirm Email Do you wish for us to contact you when your order is complete? (required)* No Yes Which contact method(s) would you prefer? Email Phone Call Text Message Number of items to order (required)* 1 2 3** **If you wish to order more than 3 items, please place additional orders. Item 1 (required)* Please be descriptive and include medication name, strength and quantity. Unclear descriptions may delay your order.Item 1 - Flavour (if applicable) See flavour list Item 1 - Is your script on file, attached below or being faxed from your Doctor? (required)* On File Attached Being Faxed Item 2* Please be descriptive and include medication name, strength and quantity. Unclear descriptions may delay your order.Item 2 - Flavour (if applicable) See flavour list Item 2 - Is your script on file, attached below or being faxed from your Doctor? (required) On File Attached Being Faxed Item 3* Please be descriptive and include medication name, strength and quantity. Unclear descriptions may delay your order.Item 3 - Flavour (if applicable) See flavour list Item 3 - Is your script on file, attached below or being faxed from your Doctor? (required) On File Attached Being Faxed Do you want us to file your repeats for easier ordering in the future? (required)* No Yes How would you like to receive your compound? (required)* In-Store Pickup Post Postal address Same as above Postal Address* Street Address Address Line 2 Suburb State Post Code Special instructionsUpload a copy of your script. Please make sure that your image is legible and of a reasonable size. Unreadable scripts may result in a delay in your order. Please note that you legally must provide the original copy of the script to the pharmacy.* Drop files here or Select files Max. file size: 8 MB, Max. files: 6. Maximum file size 5MBCAPTCHA
