Renewal of prescription

** All prescription requests may be subject to a prior consultation
consultation if your doctor deems it necessary **

The content of this message can be read and processed by our secretariat.
We process your requests as quickly as possible but do not guarantee any response time. For urgent requests, contact your center or the emergency services by telephone.

Comments
This field is for validation purposes and should be left unchanged.
Choose your doctor*
Doctor responsible for your prescription
Photographs of your medications to be refilled
You can send us a photograph of your prescription or medications that you want to renew. You can add other medications in the lower part of the form.
Drop files here or

Accepted file types: jpg, jpeg, pdf, Max. file size: 300 MB.

Supplement with other medications

You can also enter the list of the medications to be refilled here, possibly apart from the photograph above.

Medication	Dosage	Morning	Afternoon	Evening	Night	Duration
							Edit Delete
There are no Drugs.

Remarks
Collection of prescription*
Send by courier
Address*
Street and N° City ZIP
Fax to the pharmacy
Name of the pharmacy*
Fax number
(e.g.: 022 123 45 67 or 0033 4 12 34 56 78)
Your contact details
Identity*
Civil status First name Surname
Date of birth*
Day
Month
Year
Email address*
Mobile phone number*
(e.g.: 076 123 45 67 or 0033 6 12 34 56 78)
Conditions*
- I confirm that I have read the terms of the electronic communication and privacy policy and agree to receive medical information by e-mail which may be unencrypted.
  
  I understand that I can withdraw my consent at any time to receive medical information by contacting my healthcare provider or via info@magellan.ch.

Send by courier