Restricted Products Access Form

Please complete this form to allow us to assess the safety and suitability of the requested product at no additional charge. Please scan and email, or use our upload app, to send an image of prescription or referral note in support of your request. Please note that our practitioners will not always be able to make assessment on the provided information only and may request to see you in zoom or face to face consultation, pending Covid-19 lockdown conditions. 

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