Register - Script2U

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Patient Information

Name*

First Last

Email*

Password*

Mobile Phone*

Billing Address*

Australian Residents Only

Street Address City State / Province / Region ZIP / Postal Code Country

Shipping Address*

Same as Billing Address

Street Address City State / Province / Region ZIP / Postal Code Country

Upload your Prescription

Paper Script File Upload*

Paper Script File Upload

Please upload the script.

eScripts Url*

eScripts Url

Please enter the eScript url.

Script Code or Url*

File Upload*

Upload a full screenshot of your script. Both sides if neccessary.

Drop files here or

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB, Max. files: 2.

Medicare

Our pharmacists will review your medical profile to correctly dispense medication.

Medicare Card No.*

Medicare Reference No.*

Concession Card No.

Date of Birth*

DD slash MM slash YYYY

Medicare

Our pharmacists will review your medical profile to correctly dispense medication.

Reason for use*

Diabetes

Weightloss

Other

Are you pregnant or breastfeeding*

Pregnant

Breastfeeding

Not Applicable

Are you transitioning from/or using another medication?*

Saxenda

Trulicity

Sulfonylurea (glimepiride or glibenclamide)

Insulin

Ozempic

Other

If you have selected any of the above medications, when was your last dose?

Less than one month ago

More than one month ago

Do you have

Impaired renal function or kidney issues*

Yes

Pancreatitis or issues with your pancreas*

Yes

A history of diabetic retinopathy*

Yes

Problems with your liver*

Yes

Congestive heart failure or cardiac issues*

Yes

Thyroid cancer*

Yes

A family history of medullary thyroiad carcinoma*

Yes

Gallbladder disease or gallbladder issues*

Yes

Multiple endocrine neoplasia syndrome type 2*

Yes

A history of depression*

Yes

Other medical conditions no listed above

Allergies

Almost Done

I have fully disclosed the above information relating to my medical history to my prescribing practitioner*

Yes

Refund and replacement policy*

I have read and understood the above information. All answers I have provided to the questions above are truthful and accurate.

Under normal circumstances, Your Solution Compounding Pharmacy does not accept returned products due to governmental regulations. In limited circumstances, we may issue a refund or replacement.

For faulty or damaged products return requests, please call us on 1300 900 939 or email us at info@script2u.com.au. For faulty or damaged items, we will require photo evidence to assist us in the investigation of each query.

Name

This field is for validation purposes and should be left unchanged.

Register & Upload Scripts

Patient Information

Upload your Prescription

Medicare

Medicare

Almost Done