My Pharmacy

Place an Order

 

Details that we require from you:

  • Name
  • Mobile Number
  • City
  • Address
  • Image (Prescription or Medicine image)
  • Details

Pharmacy order

    Please upload the prescription or medicine image (max. 3 files allowed)
    (only .png, .jpg, .jpeg & .pdf file formats are acceptable)

    *Do not close this page until the form is submitted.
    **Please be patient as file attachments take time to send.