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Pharmacy: Medsafe Pharmacy

Address: 104-106 Miller Street
Preston, VIC, 3072

Phone: 0394841576

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B12 Injection

Duration: 15 min

B12 Injection

BOOSTRIX Vaccination

Duration: 20 min

BOOSTRIX Vaccination

GARDASIL 9 Vaccination

Duration: 20 min

GARDASIL 9 Vaccination

HEPATITIS B

Duration: 30 min

HEPATITIS B

OZEMPIC injection

Duration: 15 min

OZEMPIC injection

PROLIA injection

Duration: 20 min

PROLIA injection

SHINGRIX injection

Duration: 30 min

SHINGRIX injection

SUPERVISED RATS

Duration: 30 min

SUPERVISED RATS

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First Name*

Last Name*

Mobile*

Email*

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Dose

Medicare Number

IRN

Medicare Expiry

Name on card

Enter your Medicare number and other details to reduce your waiting time in the pharmacy.

Date of birth*

Street*

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Postcode*

Reason for consultation*

What are you experiencing with your health? Provide information to help with the consultation.

Relevant background information*

Include information relevant to your situation e.g. medication you are on, recent health issues, allergies etc.

I am consenting as a substitute decision-maker (e.g. carer) on behalf of the patient

Name of substitute decision-maker*

Consent to pilot clinical service and costs*

I agree to participate in the pilot and understand the scope of the clinical service. I consent to paying the pilot consultation fee and any costs associated with the service. I understand that if I decide not to proceed with receiving some part of a service, I may still be required to pay for services that have already been provided.

Consent to pilot evaluation*

I consent to participating in the evaluation of the pilot and agree to being contacted to participate in surveys about the pilot. I consent to my administrative health service data being analysed for evaluation purposes.

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This program closes at 4pm AEST July 31st. Do not book a vaccination after this date/time.

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