Use this form to place your order with us.

Payment:

Either Include your credit card details. 

Or If you are a NZ customer you can pay by Internet banking, HOWEVER the order will not be sent until we have confirmed the funds have been deposited. We will text or email you the details once the order is assembled.

Doctors Prescriptions:

Please state in the Prescription field that you are ordering a new prescription that we have notified you about or a Repeat/Refill as indicated on the label of you current supply.

 

Order Delivery Information
Name of person the order is being delivered to (at Checkout)
Full physical address used for delivery of the order. Our Courier does NOT deliver to PO Box in NZ.
Add Street name and number AND City Suburb if needed for Courier.
enter a landline number only if you do not have a mobile phone
Patient Information
Information relating to the person the medicine is intended for.
If this is an order for a prescription or repeat/refill of a prescription then enter details.
List the products required include pack size and quantity of each.
Comments to help us process your order
Do you suffer from any of these health conditions?
Do you have any allergies or have you reacted badly to any medicines before. If so please explain.
If you are ordering a mixture or bespoke medicine list the ingredient and potency range. For a mixture also give proportions of each ingredient or state equal parts.
Payment Details
Credit / Debit card details
full Visa or Mastercard credit or debit card number.
Enter credit card expiry date: Month / Year
Enter 3 digit security code on back of card
Name on the card
For NZ customers only. We will email you details.