ePharmacy logo
 
$0.00

Travel Medicine Registration

Company Name*
First Name*
Last Name*
Email* Your email address is your secondary form of identification and is our main method of communication with you.
Verify Email* Please retype your email address to ensure that it is correct.
AHPRA Number* A valid and current AHPRA number is required to register for an account.
Date of Birth
Gender*
Address*
Ensure that a valid practice address is provided. Residential addresses, PO Boxes, Locked Bags, and similar address types are not permitted.
City/Suburb*
State*
Postcode*
Country*
Mobile Phone
Work Phone You must enter a phone number that we can contact you on.
Username & Password Please select a username and password for future logins. Retype your password in the Verify field to ensure it is correct.
Username*
Password*
Verify Password*
IT IS A LEGAL REQUIREMENT THAT THIS FORM BE SIGNED PERSONALLY BY THE REGISTERED MEDICAL PRACTITIONER IDENTIFIED ON THIS FORM
By signing this form, I warrant that I am the registered medical practitioner identified in this document
QCPP accreditation details: ePharmacy Virginia. 1806 Sandgate Rd, Virginia Qld 4014.
Proprietors: Sam Gance and Jeffrey Wasley. Pharmacist available - Monday to Friday 8:30am to 5:30pm (AEST) Saturday 9am to 1pm (Pharmacist Only) (AEST)
**Please note that not all products available online are available in the stores. The RRP against which any savings comparisons we make to the listed sale price for products displayed on this website is: the supplier's recommended retail price for the product, provided that this is a price at or above which at least 5% of Australian Pharmacy Transactions~ have occurred for that product within the previous 2 months; or if at least 5% of Australian Pharmacy Transactions~ for that product in the previous two months did not occur at or above the supplier's recommended retail price, the RRP will be the price at or above which at least 5% of Australian Pharmacy Transactions~ occurred within the last 2 months. All prices displayed on this website are in AUD unless otherwise indicated. Actual product or product packaging delivered may vary slightly from product image shown.