Upload Script

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.

* Indicates required field

Upload an image of your Prescription *

Max file size: 20MB

Name on Prescription *

Phone Number *

Email *

Preferred Contact Method *

Delivery address *

Preferred delivery date *

If Specific date fill below

Day *

Month *

Year *

Delivery instructions: Is it ok to leave the parcel (if not home, or can't get to the door) *

Yes No

Submit