ryde@mediadvice.com.au

(02) 9878 3030

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Risk Assessment

This information is required to assess the suitability and safety of ingredients for the intended use of the compounded medication. Please fill out all questions.

Name(Required)
MM slash DD slash YYYY
Are you pregnant/planning to be pregnant/breastfeeding?
Have you had this compounding medicine before?
Flavour preference (applicable for liquids, syrups, children’s formulations):
Address
Preferred Method of Pick Up(Required)
*Please note delivery fees apply. See FAQs*
Accepted file types: jpg, jpeg, png, pdf, docx, Max. file size: 10 MB.
Upload your paper prescription or electronic prescription (QR code) with these easy steps and your medication is on its way!

Step 1. Complete your personal details and upload prescription by clicking on ‘Upload Photo or File of Prescription’ button
Step 2. We’ll confirm by calling or emailing you
Step 3. Your prescription is ready to pick up or deliver
* Note: Original prescriptions must be received prior to pick up or delivery of the prescribed medicine.

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