Nicotine Pouch Importation Prescription

  • Medical Questionnaire

    Please note that this form is HIPAA-compliant and all data is considered private and confidential, and is stored in accordance to The Privacy Act 2014. ©2024 NicotineRX

  • Thank you for choosing NicotineRX to help you with your smoking cessation journey!

    Please read and complete this questionnaire carefully. Please double check the strengths and quantities that you use before submitting. If you are not sure, please select options that reflect this so that we can contact you prior to writing the prescription.

    There is a lot of time and effort that goes into assessing individual questionnaires and writing the prescriptions, so please allow up to 24 hours to receive the prescription if approved.

    NOTE: It is not legal or ethical to backdate prescriptions, and any requests for this will be declined.

    IF YOU HAVE AN IMPORT AT BORDER FORCE WITHOUT A VALID PRESCRIPTION AT THE DATE OF IMPORT, THE IMPORT PACKAGE WILL BE DESTROYED.

    Disclaimer: NicotineRX is not affiliated with any nicotine pouch brands or companies and does not endorse specific brands or products. NicotineRX does not prescribe tobacco-containing products like 'heated tobacco', or tobacco containing snus. 

    **Many nicotine pouch brands are owned by Big Tobacco. Please do your research and do your best to not to support Big Tobacco brands. 

  • New or Repeat Assessment Declaration

    If you have used NicotineRX before, some questions will change.

  • IMPORTANT INFORMATION - PLEASE READ

    We do not prescribe more than 12,000mg of nicotine in pouches for a 3 month period. Please ensure you check the total amounts of nicotine you are importing.

    This is roughly 40 cigarettes worth of nicotine a day.

    As nicotine pouches are currently unapproved therapeutic goods, if you require more than this amount for smoking cessation, you should discuss with your doctor regarding supplementing or switching to approved therapies if you have not done so.

    You may continue with the assessment, however there will be the above limits on the prescription. If you have already imported products over these limits, this may not be allowed to enter Australia at Border Force. If you have products that meet these limits, it may still be allowed through. Please note we are not liable for any issues at Border Force.

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