ORDER FORM

Title
Name:
Address:
Telephone: ( include std code )
Email:
Date of birth:
Weight:
Method of Payment:
Shipping:Domestic (Express Post AU$ 6.00)
International (varies)
International Shipping Options:
Scripts to be Filled:
Flavors: ( troche )
Please list any allergies:
Other comments:

We cannot process your submission until we have received pre-payment from you, once you have completed the above order form:
- new customers please call us on 02 9416 2642 to arrange payment, and fax your original prescription to 02 9415 6604 or email it to order@compoundingchemist.com. Original script is to be mailed to 30 Moore Avenue, Lindfield NSW 2070 after you have faxed it.
- repeat customers, if you would like to change payment details from previous please call us on 02 9416 2642 to confirm.
- for repeat orders with current details please specify payment type above.
- for pick-up orders please specify a preferred 'pick-up' time allowing 24hour turnaround time for compounded medications, then fax your original prescription to 02 9415 6604 or email it to order@compoundingchemist.com. Please bring original prescription when you pick up your order.




West Lindfield Pharmacy & Compounding Centre
Graeme Skinner B.Pharm., M.P.S.
30 Moore Avenue, West Lindfield, NSW AUSTRALIA 2070 
Phone: 02 9416 2642   Fax: 02 9415 6604