Script Repeat

PLEASE PHONE US ON 1300 587 345
Scripts 2U Discount Prescriptions for Australian residents

COMPLETE YOUR REQUEST
Fill in the online form below

Payment is at time of prescription being filled and is by Mastercard, Visa or Direct Debit and may include a delivery fee.*

If you require assistance with your request our pharmacists are available six days per week on 1300 587 345 - 8.30am-6.00pm [Mon-Fri] 9.00am-12.30pm [Sat] Eastern Standard Time.

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1. CONTACT DETAILS For identification of your records on file with us
Full Name *		Last Name *
Home Address *		Suburb *
State *		Postcode *
Email *		Phone Number *
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2. SCRIPT REQUIRED Please specify name of drug and strength
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3. SPECIAL NOTES Any extra information that will assist

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4. PAYMENT DETAILS Please tick one of the following boxes
Please use my nominated credit card details sent with scripts and on file
Before despatch of script, please phone me for EFTPOS, Visa or Mastercard payment details


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