Get my prescription ready ! Get my prescription ready ! Main Member Initials Main Member Surname Patient Initials Patient Surname Residential Address (Number | Street | City) Contact Number Email Address Medical AidCash Medical Aid Number You have chosen Medical Aid. You agree that your Medical Aid details are correct. You agree that any co-payments will be settled by yourself. You have chosen Cash. Please note that you are required to settle your script in full. CollectionLocal Delivery Preferred Collection Date and Time Local Delivery: CARDLocal Delivery: CASH Change required for? Please upload your prescription to be filled. Please bring your original prescription with you.(Omit if valid prescription is already stored with us) Please add details to your request here (optional) You agree that your information is factually correct and that you have read our Terms and Conditions, as well as our Privacy Agreement.