Request your prescription online

It is possible to send us a request for a medical prescription online. Therefore, fill in the form completely. It is important, that you state the precise drug name, the package size and the dosage – otherwise we cannot prepare your prescription.

First name

Surname

Social security number with date of birth

Phone number for questions

Email address for confirmation

  Medicine
(Pay attention to the exact name of the medicine!)
Concen-
tration
Package
size
Number of
packages
  e.g.
Medicine name
e.g.
500mg
e.g.
60 Pc.
e.g.
2
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.


Remarks

Please be aware, that prescriptions are handed over once a medical and health insurance verification took place.

You can pick up your prescription the very next day, but don’t forget to bring your e-card with you!

Your data will be processed in accordance with our privacy policy.