Prescription

At Kiara Pharmacy, we’ve now made it easier for you to order your prescriptions without coming into the pharmacy.

If you’re concerned about coming into the pharmacy, or can’t get here, fill out the form below and pick up your prescription at the pharmacy or have it delivered to your door for free.

Prescription Order Form

First Name*
Last Name*
Date of Birth*
Date Format: MM slash DD slash YYYY
Registration Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Different Postage Address?
- Yes
Postage Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Number*
Email Address*
Preferred Delivery Method*
Special Delivery Instructions
Product(s) Ordered | Quantity*
Upload Prescription*
Drop files here or
Need help? Call us direct on (08) 9279 1114 Monday to Friday between 8.00 am – 6.30 pm and Saturday between 8.00 am – 1.00 pm (Excl. Public Holidays) DUE DATE: All products take 2 working days to make product plus 1 day delivery.
Phone
This field is for validation purposes and should be left unchanged.

PRESCRIPTION

Prescription Order Form

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