COMPOUND ORDERING Your Name (required)* First Last Do you have any allergies or sensitivities? (required)*YesNoPlease briefly listNoneStreet Address* Street Address Address Line 2 Suburb State Post Code Preferred main contact number (required)*Secondary contact numberEmail address (required)* Enter Email Confirm Email Do you wish for us to contact you when your order is complete? (required)*NoYesWhich contact method(s) would you prefer? Email Phone Call Text Message Number of items to order (required)*123****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 FileAttachedBeing FaxedItem 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 FileAttachedBeing FaxedItem 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 FileAttachedBeing FaxedDo you want us to file your repeats for easier ordering in the future? (required)*NoYesHow would you like to receive your compound? (required)*In-Store PickupPostPostal 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.* Drop files here or Maximum file size 2MBCAPTCHA
