Prescription Upload

Want to use your phone to upload your script?

Scan the QR code to open this page on your phone.
This will make it easier to upload images of your prescription taken with your phone camera.

Upload your prescription here (Max 25MB)

Contact details

First Name:

Last Name:

Phone Number:

Email Address:

Date of Birth:

Weight (kg):

Pregnancy and Breastfeeding

Are you pregnant?:

Are you breastfeeding?:

Medical History

List any allergies

List any other medical conditions

List any current medications or supplements

Full Disclosure, accurate information and consent

I have fully disclosed the above information relating to my medical history to my prescribing practitioner.
I have read and understood the above information. All answers I have provided to the questions above are truthful and accurate.
I confirm consent to order, pay and provide my personal details to Compounded.
I acknowledge that Compounded Pty Ltd must receive the original copy of my script before medication can be dispensed.

Address

Street Address*

City*

State / Province / Region*

ZIP / Postal Code*

Country*

Delivery Address*
Same as aboveDifferent from home address

Payment Details

We accept VISA and Mastercard only. You can also pay via EFT. Please provide a valid contact number and email above so that we may contact you.

Payment Type*

Delivery Details

It may take up to 2 working days to make your compound then a further 1–2 days for nationwide delivery. Upon receipt of your order we will contact you directly to advise you of expected delivery date.

Preferred delivery method*

Special delivery instructions

Refund and Replacement Policy

Under normal circumstances, due to governmental regulations, Compounded does not accept returned products. In limited circumstances, we may issue a refund or replacement.
For return requests for faulty or damaged products, please call us at (02) 9693 2313 or email us at orders@compoundedmedication.com.au.
For faulty or damaged items, we will require photo evidence to assist us in investigating each query.