PRESCRIPTIONS

• Online orders are for repeat prescriptions only
• You may be asked to have an appointment instead
• Please name a pharmacy as pick-ups are not available at present
• Pharmacies are only dispensing medications once a month at present
• Allow 2 working days for your script to be ready
• Confirmation is not required – we will only contact you if needed
• $25 / CSC $10 / 0-13 yrs Free + $5 if Fax/Post
• Please pay online to 03 0802 0175929 00 & include your name and date of birth

If you are human, leave this field blank.

First Name *

Surname *

Date of Birth *

(dd/mm/yyyy)

Phone Number *

Daytime contact number

Email *

Doctor *

Dr Mark Rogers

Dr Kim Lawson

Dr Victoria Flight

Dr Lauren Goldschmidt

Medications Required *

Please be as detailed as possible

Pick Up or Fax *

Pick up at Cranford Pharmacy [NB Pickup at ProMed Reception not available at present]

Or fax to pharmacy below ($5):

Pharmacy Name & Address

Submit