Suite 1.1, Level 1
48 Flemington Road
Parkville Victoria 3052
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Tel: 03 9345 6888
Fax: 03 8374 3860
Your action plan and script will be issued within 7 business days – please contact us to ensure that this can be done.
A $30 fee is applicable. Please be advised we apply 1% surcharge. Please note, If your child is not a patient of MACCS Medical Group we will not be able to issue you an action plan and/or script
Please complete the following details for your child's action plan.
01. Your child's details:
02. Current photo of your child:
03. Family/Emergency contact:
04. Who is your child's allergy specialist?
05. Do you require a:
06. Which food allergens does your child avoid?
07.What is your child's approximate weight?
08. Which antihistamine does your child usually use?
09. Adrenaline autoinjector prescribed?
10. Does your child have asthma?
09. Does your child have asthma?
10. Do they have asthma symptoms occuring 1x/week or more?
11. Do they have asthma symptoms occuring 1x/week or more?
10. Do you need an Epipen script?
11. Do you need an Epipen script?
12. Do you need an Epipen script?
01. Please send my script to.
02. Your Chemist Details