Go Rush Guest PANAGA Order

Bahasa Melayu English

PHC PHARMACY

[[ms]]Adakah awda mendaftar untuk orang lain?*:[[en]]Are you registering for someone else?:*YesNo

Requester Name:*

Requester Contact Number:*

[[ms]]Apakah hubungan awda dengan pesakit?:*[[en]]Requester's relationship to Patient?:*

[[ms]]Seterusnya[[en]]Next

Are you under Quarantine Order?*YesNo

Please select your delivery method:*Standard

Available Pick Up Days: Wednesday & Friday

1 Patient Number = 1 Charge

Price Charge: $3

Price Charge: $5

Price Charge: $20

Delivery Duration: 5-7 working days after Go Rush receives the medication from Pharmacy.

Delivery Duration: 2-4 working days after Go Rush receives the medication from Pharmacy.

Delivery Duration: Within 3 Hours after Go Rush receives the medication from Pharmacy.

Orders submitted before 12pm will be processed today. Orders submitted after 12pm will be processed the next day.

Immediate orders ($20) will only be accepted until 12pm and will not be available on Friday and Sunday.

[[ms]]Nama Pesakit:*[[en]]Patient's Name:*

Identity Card Number or Password?:*IC NumberPassport Number

IC-Number:*

Passport Number:*

Date of Birth:*

Contact Number:*

Additional Contact Number:

Patient Number:*

[[ms]]E-mel:[[en]]Email:

Delivery Address:*Next

Self-Collection Date:*Next

Payment Method:*Cash

Harap Maklum:-

Bayaran hanya boleh dibuat setelah mendapat ubat. Hantarkan bukti pembayaran ke +6732332065 melalui Whatsapp dengan maklumat awda:

Nama:

Patient no:

Please Note:-

Payment only can be made after receiving medicine. Send Proof of payment to +6732332065 via Whatsapp with your details:

Name:

Patient no:

Remark:

I acknowledge that my medication will only arrive within 5-7 working days for standard delivery after Go Rush receives the medication from Pharmacy.

1 Patient Number = 1 Charge
‍
Terms and Conditions Applied*

I acknowledge that my medication will only arrive within 2-4 working days for express delivery after Go Rush receives the medication from Pharmacy.

1 Patient Number = 1 Charge

Terms and Conditions Applied*

Agree

Please wait...

[[ms]]Terima Kasih![[en]]Thank you!

[[ms]]Pihak kami telah menerima tempahan awda.[[en]]We have received your request order.

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