Update My Profile | The Medicine Chest Pharmacy

Take a moment to update your profile to keep us up to date with your contact details as well as your allergies and special requirements. If you would rather use a pen and paper form please click here to download it.

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* Required information.
Member's First Name *
Member's Surname *
Email address *
Street & House No. *
Suburb
City / Town *
Primary Contact No. *
Secondary Contact No.
Skype Address
Newsletter?
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Date of Birth *
Medical Aid Society 1
Member No.
ID Number
Medical Aid Society 2
Member No.
Allergies. Please indicate your allergies by ticking the box next to the corresponding allergen.
AAS - Aspirin Allergy
ABA - Barbiturates Allergy
ACE - Cephalosporins Allergy
ACH - Chloramphenicol Allergy
AER - Erythtomycin Allergy
AME - Methylxanthines Allergy (Caffeine and Theophylline)
ANS - NSAID Allergy (Non-steroid anti-inflammatory drugs)
AOP - Opiates Allergy
APE - Penicillin Allergy
APH - Phenathaizine Allergy
AQU - Quinolones Allergy
ASU - Sulphonamides Allergy
ATE - Tetracycline Allergy
Other Information We Need to Know

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