UPLOAD YOUR PRESCRIPTION Upload Script ◆ We’ll be in touch soon to discuss your medication and arrange payment. ◆ Pick up in Toowong or choose express shipping Australia-wide. ◆ Found a better price? Ask us about price matching. THIS FORM IS BEING SUBMITTED BY A PRACTITIONER THIS FORM IS BEING SUBMITTED BY A PRACTITIONER Clinic Name(Required)Clinic Email(Required)Clinic Phone Number(Required)Person In Charge Of Payment(Required) Clinic (we will call clinic phone number above) Patient (we will call patient phone number below) Prescription Type(Required) New Prescription My Skin Pharmacy Refills Item(s) required, Previous Prescription Number (if known)Delivery OptionI want my prescription postedI will pickup my prescription from My Skin PharmacyYour Name(Required) Full Name Your Phone(Required)Your Email Address(Required) Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanÃ…land IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Upload Prescription File(For eScripts, please upload a screenshot of the QR Code or Barcode with the 18-digit alpha-numeric code) Drop files here or Select files Max. file size: 256 MB. Message: Mail Us Your Script To comply with Pharmacy Regulations, please supply the original copy of the script via post within 7 business days to My Skin Pharmacy – Shop 1, 530 Milton Road, Toowong QLD 4066. If your script is an eScript, we do not require the original copy to be posted. We will contact you as soon as we receive your script. Payment & Delivery Our staff will contact you by telephone to finalise payment. We use Australia Post Express. Please see the shipping price schedule for more information. Payment & Delivery Information Our staff will contact you by telephone to confirm your order, payment and shipping options. Shipping: Please see the shipping price schedule for more information. CAPTCHAPrivacy(Required) I agree with the storage and handling of my data by this website. - Privacy Policy *
