Contact Form - Secure Online Payment (Polipay) for Script Form (#6) (#12) Secure Online Payment (Polipay) Use this form to prepay securely online via Polipay direct from your bank account, to facilitate prescription handling. See supported banks Else prepay the appropriate prescription fee to our bank account (Westpac 03-0162-0098557-000) or via telephone payment (call or email), to facilitate prescription handling. First NameLast NameEmailMobile number (preferred) else Telephone numberPrescription - Recipient enrolment and When Needed $40 Urgent (24 hours) - for enrolled patient $30 Standard (2 working days) - for enrolled patient $29 Urgent (24 hours) - for enrolled patient with a valid CSC card $19 Standard (2 working days) - for enrolled patient with a valid CSC card $55 Urgent (24 hours) - for casual/visitor/unenrolled patient $45 Standard (2 working days) - for casual/visitor/unenrolled patientFee $NZDPay Fee via Polipay
