Compounding patient assessment form 

This medication will be compounded specifically for you as there isn’t a commercially available TGA (Therapeutic Goods Administration) registered product.

A VALID PRESCRIPTION IS REQUIRED FROM YOUR DOCTOR

Thank you for taking the time to fill out our assessment form.

As a part of our Standard Operating Procedures, we require this information to assess the best options for your compounded medication so we can provide a product that is best suited to your individual needs. 

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You may receive a phone call from our compounding pharmacist if further clarification is needed.