Suite 1.1, Level 1
48 Flemington Road
Parkville Victoria 3052
View Google Map
Tel: 03 9345 6888
Fax: 03 8374 3860
A $30 fee is applicable. Please be advised we apply 1% surch (same as what you currently have written)
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 script request.
01. Script required
02. Who is your regular allergy specialist?
A. Steroid Ointment Brand
B. How many tubes used per month?
A. EpiPen strength required
B. What is your child's approximate weight?
C. Has your child had an EpiPen issued in the previous 6 months?
D. Does your child have asthma?
E. Does your child have asthma symptoms occurring 1x/week or more?
A. Nasal steroid spray brand
A. Montelukast (Singulair) strength
B. Do they have asthma symptoms occuring 1x/week or more?
A. Flixotide strength
B. Flixotide dose
C. Flixotide frequency
D. Is your child using Flixotide with a spacer?
F. Would you like to contact your allergy specialist for an asthma review?
A $30 fee is applicable. Please be advised we apply 1% surcharge to all of our card transactions.
01. Patient Details
02. Parent/Guardian Information (if applicable)
03. Contact Details
You receive 2 per year at a discounted rate, any more can be purchased at full price over the counter at a pharmacy.