Only controlled medications to be picked up from the pharmacy. All other medications delivered to you - fee will be paid when recivieng . Please fill the follwoing form to order your medications. Patient MRN * Note In case there is more than one prescription that needs to be mailed to the same address, please fill the form once and add all required medical record numbers. Patient Name * National ID * Pickup method * - Select - Through express mail (Registered only, conditions apply) Location/Address * Mobile Number * Notes Service Terms and Conditions The form should be filled out from 8 am to 3 pm; and will be received the following day. Forms submitted after 3 pm will be received after 2 working days. Prescription refill requests made during the weekend (Friday & Saturday) will be processed on Sunday morning. Leave this field blank
