Upload Your Prescription

Please complete the form below to upload the prescription you want us to dispense and deliver to you.

We would get back to you as soon as we can with further details about the cost of your prescription and when it would be dispatched.

By using this service:

You consent to us contacting the prescriber if there is a need to do so
You agree to answer all questions asked in the questionnaire honestly
You will inform us immediately of any changes to your health or prescription needs
You agree to read all patient information leaflets supplied with your prescriptions

Please note that:

It might take up to 48 hours for your prescription to be dispatched to you. If any unforseen circumstances would lead to a longer delay in dispatching your prescription, we would inform you as soon as possible
Our pharmacists are registered with the Pharmacy Council of Nigeria (PCN)
Once your medication has been dispatched, one of our pharmacists will contact you to give you advice on how to take your medicine(s)

ABOUT THE PATIENT ie the person whom the prescription is for

Patient's first name (required)

Patient's last name (required)

Patient's email address (required)

Patient's mobile number (required)

Patient's date of birth (required)

Is the patient allergic to any medication? (required)

List of medications, food or substances patient is allergic to? (if applicable)

What does the patient weigh? (required for children or weight dependent dosing)

Is the patient on any other medication not included in the prescription you want to upload today? (required)

List of other medications the patient currently takes? (if applicable)

ABOUT THE PRESCRIBER ie the person who wrote the prescription you want to upload today

Who is the prescriber? (required)

Prescriber's first name (required)

Prescriber's last name (required)

Prescriber's email (required)

Prescriber's mobile number (required)

Name and address of prescriber's clinic or hospital (required)

DELIVERY DETAILS ie where the prescription is to be delivered to

Street and house number (required)

District or Local Govt Area (required)

City (required)

State (required)

Country (required)

Is there anything else we need to know? (if applicable)

Please upload your prescription (or manually enter your prescription below)
File limit 500,000 bytes (500kb); filetypes: jpeg, jpg, pdf, png, doc

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