Drug Delivery Form

0205320009 | 0550464810

BOOK AN APPOINTMENT

DRUGS DELIVERY SERVICE

We deliver your medication in a timely manner

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Enter Name

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Age

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Enter Phone Number

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Enter Address and Location

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Enter City

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Enter Region

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Present Medical History

Drug AllergyAre you Allergic to any medication?

Yes

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No

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If YES state the name(s) of the drugs.We want to know the drug(s) you are allergic to? Your Answer here

Your Current Medication

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List of Drugs

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Chronic Disease management

WORKING HOURS

Office Hours

Monday - Friday -

8:30a.m - 5:30p.m.

Saturday -

9:00 a.m. to 1:00 p.m.