Medication order form

The medication order form allows parents and guardians to pre-order their child’s medications online. Simply complete the form below, allow three business days for processing, then collect your order at Perth Children’s Hospital (PCH) Pharmacy. We also offer a postal service for rural patients who live more than 70km from the hospital. 

Completing the form

Please complete the form below, making sure all sections are completed and the information is correct. You will receive an email confirming your order once submitted.

Attaching prescriptions

If the prescription is new, you will need to attach the patient/pharmacist prescription form.


Patient/pharmacist prescription form

If the prescription has been dispensed at least once before, we will need:
  • the patient/pharmacist prescription form
  • the repeat form.

[Repeat form]

Processing your order

We require a minimum of three working days to process your order. 

The Pharmaceutical Benefits Scheme (PBS) (external site) limits the supply of some quantities to one month only. We may adjust the quantities you have requested based on these limits.

When your order is ready for collection, you will receive an SMS to your supplied mobile phone number.

Collecting your order

The Outpatient Pharmacy is on Level 1 at Perth Children’s Hospital, accessible by the pink lifts.

Please bring all the original copies of your prescription when you come to collect your order.

When you arrive to collect your order there will be an additional wait time (on average 10-15 minutes) whilst the original prescription is checked against the pre-prepared order. We will prioritise this process, but ask for your understanding that this is required for both legal and safety purposes.

Postal service for rural patients

We only post medications out to patients who live over 70 kilometres from PCH. If you are unsure of your eligibility, please call Pharmacy on 6456 0190.

Contact us

If you are have having trouble submitting this form or have a question about your order, please contact Pharmacy on 9456 0190.

Medication order form

Child details

Date of Birth
Type NIL if none known
Do you have a concession card?
Parent / Guardian Details
An SMS will be sent when your order is ready for collection.
Prescription upload

Scan or take a photo and upload copies of your child's prescriptions. Please make sure scans and photos are clear and text is clearly readable, otherwise we may not be a able to process your order.

Ensure to bring original copies of prescriptions and repeats when collecting your medication.

Accepted file types include .jpg, .png and .pdf and can note exceed 1MB in size.

Postal service to country patients

We can only post medications out to patients living in rural Western Australia. This is generally over 70 kilometres from the hospital. If you are unsure of your eligibility, please call us on xxx xxxx. We require the original prescription to be kept at the PCH pharmacy.

If you select this option and you are not eligible, we will prepare your prescription for collection and notify you.

We can NOT post to PO boxes. A signature is required on delivery.
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