Healthlink Online Pharmacy

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PERFUMES & FRAGRANCES

HOUSEHOLD AND DOMESTIC

SURGICALS & HOME HEALTH

SKIN CARE AND MEDICATION

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Simply fill in the following form. Required fields are designated with an asterisk (*).

Personal Details

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Delivery Address

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Allergies

To help us provide you with the highest quality of service, please answer the following questions.

Do you have any of the following drug allergies?

Please tick the appropriate box(es):

No Drug Allergies	Aspirin
Codeine	Ethromycin
Penicillin	Sulpha
Tetracycline

Other drug allergies

Do you have any of the following medical conditions?

Please tick the appropriate box(es):

No Chronic Conditions	Arthritis
Asthma	Diabetes
Epilepsy	Thyroid
Stomach Ulcers	High Blood Pressure
Glaucoma	Heart Condition

Other medical conditions

Prescribed Medicines

Not regularly taking any prescribed medicines - or -

Regularly taking medicine(s) that have been prescribed by a doctor or dentist

The names of these medicines

Non Prescription & Other Medicines

Not regularly taking any non-prescription medicines - or -

Regularly taking medicine(s) obtained without prescription (Including from a pharmacy, supermarket, health food shop etc) eg. for headache, heartburn, etc. (including herbal and complementary medicines)

The names of these medicines

Please note that to purchase prescription medicines from Healthink Online Pharmacy, you must provide your Medicare card details, and if applicable, your concession details. Healthlink Online Pharmacy will not dispense prescription orders until we have received your prescription in the post and processed it. Please post your prescription to:

Unit 2/52 Highclere Boulevard
Marangaroo, Western Australia 6064

Medicare

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Concession

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Email Contact

The Healthlink Pharmacy website is constantly updated with new product information. We would like to keep in touch with you to let you know what's new.

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