. Vaping Customer Enquiry FormUse this form to apply for a vaping product membership. Please enable JavaScript in your browser to complete this form.Patient Name *FirstLastEmail *Mobile Number *Land Line NumberVaping Prescription Details *I have a paper script for a Vaping ProductI have an eScript for a Vaping productYou already have my script for a Vaping product on fileI need help to get a script for a Vaping productUpload your Vaping product paper script (and any supporting information) * Click or drag files to this area to upload. You can upload up to 5 files. Enter your first Vaping product eScript URL *Enter your second Vaping product eScript URLEnter your third Vaping product eScript URLWe can only supply prescription medicine if you have a valid prescription in hand. Here are two service options for you to consider to get a prescription. Choose the one you want from the drop down menu on this page, or the blue button, below. Both options support Vaping prescriptions. Telehealth Appointment (via DocLink) Service: Book a time for our staff to call you. You will have a quick phone consultation with our pharmacy staff and then you will be called by one of our GP partners who will have all your details to allow a fast prescription to be issued directly to our pharmacy. You can then collect your medicine in store or have the prescription delivered. Nurse Practitioner Service: This is a service offered in store at the pharmacy. Appointments can be made according to our Nurse Practitioner availability. Active Script List onlineI consent to the pharmacy accessing my Active Script ListI do not consent to the pharmacy accessing my Active Script ListPlease ask me about thisIs there anything else you want to let us know?Submit
