Pharmacist: request a prescription

Send a prescription request directly to the patient's doctor.

Request details

Doctor

Pharmacy name

Pharmacist name

Pharmacy phone

Pharmacy email

Patient name

Patient ID number

Patient phone

Medications requested

Medicine name

Date

Strength

Dose

Number of repeats

Payment method

Invoice pharmacy R100 (pharmacy collects from patient, settles with doctor later)

Medical aid

This prescription fee will be invoiced to the pharmacy. The pharmacy collects cash from the patient and settles with you later.

Notes