Compounding Service Order Form—LISMORE
Placing your order 1. Phone or email us if you would like information on services, including prices
2. Complete the form below, placing a in the appropriate boxes
3. Mail your order form and original current prescription to us
Contact information: Mr Mrs Miss Ms Other title:_____
First Name:__________________________Last Name:_____________________________ Postal Address:_____________________________________________________________ ___________________________________Postcode:_______________________________ Phone number (daytime):_________________Mobile Number:__________________________
Prescription Repeats held New script attached Item/s required: Quantity: _________________________________________ _______________________ _________________________________________ _______________________ _________________________________________ _______________________ (eg progesterone cream/DHEA capsules etc) (eg 2 jars or 50 capsules etc)
Official claiming receipt for private health fund required? Yes No
Payment method Visa Mastercard American Express Cheque/Money order Direct Deposit Card holder’s name:__________________________________________________________ Card number Expiry date / For ease of ordering can we retain your payment details? Yes No Direct Deposit If you would like to pay online or at a bank by direct deposit please find the bank details below: Account name: Pharmacy Management Lismore BSB: 062 674 Account Number: 1016 6831
All of our compounded services are sent via express post to enable fast delivery and tracking of the parcel.
Traditional preparations We also make traditional remedies using original formulas that are available without prescription. Please turn the page for further details.
_________________________________________________________________________ Lab Address: 89-93 Keen Street Lismore NSW 2480 Email: firstname.lastname@example.org Postal Address: PO Box 133 Lismore NSW 2480 Website: www.blooms.net.au Free call number: 1800 243 647 Proprietor: Elaine Unsworth B.Pharm Fax number: 02 66 214 020 Proprietor: Greg Cadorin B.Pharm
Supplying compounded medications all over Australia
Based in Lismore, in northern New South Wales
We use both traditional and modern pharmacy methods to prepare special medications to prescription requirements.
Bio-identical hormones for men and women
Analgesics (including pain relief creams)
We have a large range of bio-identical hormone products in a variety of dosage forms available on prescription from your Doctor.
WHY USE US?
Our prices are highly competitive with other compounding chemists
We have been providing compounding as a service for over 10 years
Provide free information packs to Doctors on their request
Our special base cream is a propriety formula made from locally-produced Macadamia oil.
TRADITIONAL PREPARATIONS—Available without prescription Traditional NE Ointment 25g
Contains an antiseptic and may reduce the itch and discomfort
associated with dermatitis and psoriasis.
May help in the treatment of eczema, pimples, blemishes,
An antiseptic ointment with natural oils for the skin that may
Natural ingredient restores tone to over-relaxed throat muscles 75.00
and may be beneficial in the treatment snoring. One bottle lasts three months.
An iodine supplement to be taken diluted in water. Purchasing
Top-to-toe Macadamia Oil 200mL
A pure, cold-pressed oil produced in northern NSW. Excellent
Works as a barrier cream and may also nourish the skin. May help 8.95
Pure and mild facial toner for all skin types. Use after cleansing
Wonderful for face and body. With macadamia oil, the “secret”
ingredient of many big-name cosmetic brands.
May soothe the itch and discomfort associated with mosquito
bites. It may assist in taking the heat out of sunburnt skin.
Helps to soothe insect bites, especially sandflies. May assist in
Table of Contents Part I . 30 The Institutional Framework. 30 A. International Co-Operation. 30 I. The Council of Europe’s Anti-Doping Convention . 30 1. The Council of Europe and the Anti-Doping Convention . 30 2. Aim of the Convention. 31 3. Main Provisions . 31 a) Definition and Scope . 31 b) Domestic Co-Ordination . 31 c) Measures to Restrict the Availability and Use of Doping Agents
TEMA 1.- CONCEPTO Y ESTRUCTURA DEL DERECHO DEL TRABAJO I. DERECHO DEL TRABAJO: CUESTIONES INTRODUCTORIAS EL DERECHO DEL TRABAJO COMO SISTEMA NORMATIVO: FUENTES DEL DERECHO DEL TRABAJO: CONCEPTO Y CLASES Normas internacionales: en espacial la actividad de la Organización Internacional del Trabajo (OIT) Derecho Social Comunitario: Fuentes, competencias y FUENTES AUTÓNOMAS O DE ORIGEN PROFES