Repeat prescription 重复处方
1 person per form please. 请一个人填写一份表格
This service is for registered patients only.
Prescriptions will take up to 1 working day to process.
The cost is $8 for 14-17 yrs old, $13 for adults and free for under 14 yrs old
此服务只适用于诊所注册病人。
处方需要一个工作日来处理。
14-17岁收费$8,成人$13,14岁以下免费。
Name 姓名
*
First Name 名
Last Name 姓
Date of birth 出生日期
-
Day
-
Month
Year
Date
Weight (under 16) 体重(16岁以下)
kg / 公斤
Phone number 电话
*
Email 电邮
example@example.com
Medications required (1 per line)需要的药物(每行1个)
*
Pharmacy 药房
*
Payment 支付
*
Bank Deposit 直接银行转账
Credit card 信用卡
Pay in clinic 診所付费
Child 0-13 Free ,0-13 岁免费
Bank details
银行账户
ASB bank: 12-3033-0051764-00
account name: Wattle Healthcare ltd
reference: name, date of birth
$13
Age 18 and above | 18岁以上
$8
14 to 17 years old | 14 至 17 岁
Payments
*
prev
next
( X )
Adult age 18+ 成人18岁以上
$
13.00
NZD
14-17 years old / 岁
$
8.00
NZD
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