Upload Your Prescription

Upload Your Prescription
3 Easy Steps

Step 1. Complete your details and upload Prescription on this form

Step 2. We’ll confirm by calling or emailing you

Step 3. Your prescription is ready to pick up or deliver

* Note: Original prescriptions must be received prior to pick up or delivery of the prescribed medicine.
Name *

First Name Last Name
Phone *

Area Code Phone Number
E-mail
Preferred contact method
Upload an image of your Prescription
Upload an image of your Prescription
Enter the message as it's shown *
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