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Patient Initials

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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

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Please upload your prescription to be filled. Please bring your original prescription with you.(Omit if valid prescription is already stored with us)

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