Submit Prescription Frechem Pharmacy. Terms & Conditions I have read & agree to the below Terms & Conditions. Please read the following: • I understand that not all prescriptions will be eligible for approval, a pharmacy team member will contact me if my prescription is not eligible. • I understand that a pharmacy team member may contact me when my prescription is ready (wait-time may vary). • By submitting this form, I am consenting to the collection and use of my personal information for the purpose of submitting my prescription to be filled by Frechem Pharmacy. • I understand that my prescription and personal information will processed and stored by Frechem Pharmacy. First Name Last Name Sex Male Female Prefer Not To Disclose Date of Birth E-Mail Phone Number Your Address Do You Have Any Allergies? Yes No Please List Your Allergies: Submit image(s) of your prescription Please ensure you follow these guidelines when taking each photo: • Keep your prescription completely in frame and in focus. • Enable your camera's flash. • For best legibility, place your prescription on a flat surface and hold phone parallel to the prescription. • Acceptable file types are jpg, png and pdf. By submitting this request your prescription photo(s) will be forwarded to Frechem Pharmacy. If you have any question or concern you may contact the pharmacy at +254-769-514-077. Submit
