Drug request

You can now submit your request for drug(s) FOR YOUR KNOWN CHRONIC TREATMENTS via this form.

Please specify the drug name, dosage, and type of box if necessary.

72 hours after your request, your prescription will be available on your identity card. All you have to do is take it your swimming pool slides pharmacy with it.

Name

First name

Phone number

Date of birth

E-mail address

Choice of doctor:

Take your pick:

Drug names, dosages and number of tablets for each drug.

Drug request

For further information: