Step 1 of 812%Your accountYour detailsLet’s start by collecting some basic contact information. QUICK NOTICE: The following medications can't be dispensed using our service. We apologise for any inconvenience caused. 1. Schedule 8 medications (also known as drugs of dependence) 2. Any refrigerated medication (eg. vaccines and other injections requiring cold chain delivery)First name*Last name*Date of birth*Gender Female Male Prefer not to respondEmail Address* Mobile Phone Number*How did you hear about us?Choose an optionDoctorCaregiverReferral from a friend or colleagueGoogleFacebookInstagramWord of mouthAt a shopping centreOnline AdCommunity ForumReview SiteI saw SimpleDose on someone else's websiteOtherWho is the order for?* I am ordering on behalf of myself I am ordering on behalf of another personCarer's First Name*Carer's Last Name*Carer's Mobile Phone Number*By continuing, you agree to SimpleDose's terms of use and privacy policyYour accountMedicare & Healthcare Card DetailsSimpleDose works with Medicare Australia, meaning that Pharmaceutical Benefits Scheme (PBS) pricing is applicable at general rates, and concession rates if you enter your concession card details here. If you've already reached your safety net threshold this year and want us to carry this forward, SimpleDose requires you to send your PRF Safety Net Report to support@simpledose.com.au within a few days after sign up. This report is available from your previous pharmacy. And if you're an NDIS participant, we will contact your plan manager to provide shipping at no cost to you.Medicare Card Number*Medicare Card Reference Number (next to your name on the card)*Valid toMonth*Month010203040506070809101112Year*Year20212022202320242025202620272028202920302031Healthcare or Pensioner Concession Card CRNHealthcare or Pensioner Concession Card Expiry DateIs the safety net important to you? No Yes Yes, and I have already reached my safety net for the yearWhat is your Safety Net (CN card) number?*Safety net Concession (SN card) number?*NDIS I am an NDIS ParticipantWho is your NDIS plan manager (or type self-managed / NDIA-managed)?*Close the Gap (CTG) I am registered for CTGDepartment of Veterans Affairs (DVA) I have a DVA CardDepartment of Veterans Affairs (DVA) Card NumberDepartment of Veterans Affairs (DVA) Card Colour (if applicable)?GoldOrangeWhiteAlmost thereYou’re half way there!Now it's time to configure your order over three easy steps:1.) Add medications to be packed in your dose sachets 2.)Then add everything else you want to receive regularly in original packaging (creams, inhalers, patches, as-needed medication, specialty medication) 3.) Add vitamins & supplements. Note that these are also conveniently packed in your dose sachetsYour serviceAdd MedicationWe pack medication by date and time. We can also include everything else shipped in original packaging like creams, inhalers, patches & specialty medications.If you have a preference for a brand, or if you take medication irregularly, fill in what you can, sign up, and contact us during or after sign up. We offer everything a traditional pharmacy would, at competitive prices.Add prescription Medication name Select your dose times & associated pill quantities (quarter = 0.25, half = 0.5) Total number of pills per day:Actions EditDelete There are no Medications to be Packed. Add Medication to be Packed Maximum number of medications to be packed reached. Inhalers and creams Medication name StrengthActions EditDelete There are no Everything Else. Add Everything Else Maximum number of everything else reached. Your serviceVitamins & Supplements packed in dose sachetsDo you take any vitamins & supplements?Vitamins & supplements play an important role in keeping you healthy, and dose consistency is key. Add individual vitamins and supplements, or alternatively add a bundle.Vitamins & supplements Vitamin or Supplement Name StrengthActions EditDelete There are no Vitamins & Supplements. Add individual vitamin or supplement Maximum number of vitamins & supplements reached. Bundle productsImmunity BundleVitamin CVitamin D3ZincOnly $0.87 per day Add to packBrain BundleVitamin B12MagnesiumGinkgoFish Oil High StrengthOnly $1.47 per day Add to packEnergy & Fatigue BundleVitamin B Complex (high strength)Vitamin B12IronCoQ10Only $1.53 per day Add to packHairloss BundleVitamin CVitamin D3ZincFish Oil High StrengthOnly $1.12 per day Add to packYour accountYour Regular GP & Medical CentreTo help make life more convenient for you, we contact your GP directly for your medication profile, regularly. We also work with them to handle any changes to your medication. If you don't have a GP, please enter your specialist's name & medical centre instead.Add your GP medical centre Medical Centre Name Medical Centre AddressActions EditDelete There are no GP & Medical Centres. Add GP & Medical Centre Maximum number of gp & medical centres reached. We aim to coordinate directly with your GP, and with your consent, begin by requesting a copy of your medication profile to provide enhanced safety. I Consent for SimpleDose to request a copy of my Medication Profile directly from my doctorYour serviceYour Shipping AddressWe send medication right to the door. Where should we send the order?Note that we can ship to your work address, home address, or your PO boxStreet Address*Street AddressSuburb*Postcode*State*If no one's home, how would you like us to handle your delivery?*Please select oneLeave in a safe place, out of the sun (authority to leave)Leave at front door, out of the sun (authority to leave)Leave at back door, out of the sun (authority to leave)Leave at apartment block receptionSign on delivery (mandatory for apartments with no reception)Other.Other Note*Your serviceSome final thingsPlease accept the following where applicable We want to make your SimpleDose experience as convenient & safe as possible, so just need a few final thingsBrandsWe will be filling all prescriptions & vitamins with pharmacist recommended brands, unless you indicate that you'd prefer specific brand names, which will incur additional charges. Note that we cannot guarantee availability of all brands. I'm OK with pharmacist recommended brandsSelect your Health ConditionsHealth Condition NameDiabetesHeart diseaseCholesterolMental illnessDepressionAnxietyHypertensionArthritisOsteoarthritisDementiaPregnancyChronic Lung conditionChronic Liver diseaseChronic Kidney diseaseCancerEye problemsOtherOther Health ConditionsDo you have any allergies? I don't have any allergiesWhat is your preferred SimpleDose start date?You probably have some medication on hand that you want to use, so let us know what date you want your first packet to start from, at least 14 days ahead of timePrefer start dateeScript details* With the help of my Doctor to send my eScripts directly to SimpleDose, I agree to remain one month in advance on my prescriptions, and acknowledge that not doing so may result in being charged at a private rate, which can be substantially higher than a PBS subsidised rate. I consent to SimpleDose accessing my Department of Health Active Script List I agree to receive written, SMS & email notifications that my medication is running low, and to contact my doctor or clinic promptly for a new prescription when I receive these friendly reminders.Some final checkpoints* I acknowledge and accept the terms of use and the privacy policy & consent to the collection and use of my personal information, in accordance with the privacy policySome final checkpoints Where I am submitting this order on behalf of the customer, I declare that the customer has consented to the collection, use and disclosure of their personal information in accordance with the privacy policy, or in circumstances where the customer does not have capacity to consent, I consent to the collection, use and disclosure of the customer’s personal information in accordance with the Privacy Policy on their behalf.PhoneThis field is for validation purposes and should be left unchanged.