eScript Upload

Thank you for using the Compounded Electronic Prescription service!

Please complete all the details below and press the ‘SUBMIT’ button.

Add your eScript tokens here: (e.g. DCQ73KRYGD45RR53447). Click 'Add' to enter each token.

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 current medications or supplements

List any other medical conditions

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 to arrange payment.

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

Order Details

Current Practitioner*

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.