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Info
Semaglutide shortage orders click here
NEW PATIENT FORM
Please be aware of your own personal security and do not email/add credit card or sensitive information within this form.
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Male
Female
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Are you pregnant?
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No
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Are you breast feeding?
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No
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Pick up
Delivery
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*If you chose delivery, please ensure you entered the correct address above.
Upload Script Pdf/Word
(Max 15MB)
Upload Script Pdf/Word
(Max 15MB)
Upload Script Pdf/Word
(Max 15MB)
Upload Script Pdf/Word
(Max 15MB)
OR
Upload Script IMAGE
(Max 15MB)
Upload Script IMAGE
(Max 15MB)
Upload Script IMAGE
(Max 15MB)
Upload Script IMAGE
(Max 15MB)
​​If you have more than four prescriptions to upload, please submit them all together in one email to
info@yscp.com.au
. ​
OR
I understand this is a New Patient Order and will recieve a Quote before my order is placed.
Send
Thank you for Your Order!
Are you ordering Semaglutide?
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