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Christina | My Skin Pharmacy

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Hi, I'm Christina. How can I help?

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PRESCRIPTION UPLOAD

Phone

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What to expect

Submit. Upload your prescription or request a refill.
Review. Our pharmacist checks your request and contacts you if needed.
Prepare. Our compounding team prepares your medicine.
Receive. Collect your medicine or have it delivered.

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)

Contact Person For Payment(Required)

Clinic (Our Pharmacy will call clinic phone number above)

Patient (Our pharmacy will call patient phone number below)

TAKE A PHOTO OF YOUR SCRIPT

Drop files here or

Max. file size: 10 MB.

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.

Patient's Name(Required)

Patient's Contact Number:*(Required)

Delivery Option(Required)

Email(Required)

Address

Address Suburb State Postcode

MESSAGE:

Add any comments or special instructions here.

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