Repeat Prescription Order Form

Please note you will receive a confirmation email once PCNZ have received your completed repeat request form.

We will phone you to confirm your payment details, our standard turnaround time is 3-5 working days from receipt of payment. This time frame may also depend on raw material availability.

*Please note: this form is not to be used for new prescription orders, please send these by post to PCNZ, P.O. Box 101-142, North Shore Mail Centre, Auckland, 0745



Full Name* :
Daytime Phone* :
Email Address*:
Address*:
Delivery Address (if different):
Please indicate the product NAME and STRENGTH below (e.g. Progesterone 20mg/g Cream 50g )
Product #1* Number of repeats*
Product #2 Number of repeats
Product #3 Number of repeats
Deliver or Collect?
If you wish to order your product in advance and then collect direct from PCNZ, then please select 'I will collect' from the drop down box below.
Please confirm*
If you want to collect your order from PCNZ, we will advise you by phone or email when it is ready.
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