Medicine Repeat Request

No Retail Sales – Medicines are continued as per the advice of doctors at Dr. Kalyan Banerjee’s Clinic

    Patient's Name*
    Case Number*
    Email*
    Gender    
    Date of Birth*
    Country*
    State*
    City*
    Address*
    Pin Code*
    Contact Number*
    Preferred mode of delivery of medicine
    Please note that an additional charge of 100INR is levied per prescription for pick up in Noida or Gurgaon for all medicine repeat requests.

    Any Special Instructions    Maximum 2000 characters
    If no instructions are provided then the last prescription shipped or collected from the Clinic, will be issued in the same quantity and form. Please provide details (serial numbers or names) of any medicines which may not be required, required in higher  or lesser quantity or required in a different form (liquid dropper, globules) etc.

    Select preferred pickup location    DELHI: I - 1691, Chittaranjan Park, New Delhi - 110019, INDIA. Timing: 09:00am to 1:00pm and 4:30pm to 8:00pm. Closed on Thursdays.NOIDA: 264, Block 1, First Floor, Ganga Shopping Complex, Sector 29, Noida. Timing: 10:00am to 01:30pm and 2:00pm to 7:00pm. Closed on Thursdays.GURUGRAM: 2nd Floor, Q 5/13, DLF Phase 2, Gurugram, Haryana 122022. Timing: 10:00am to 1:30pm and 2:00pm to 7:00pm. Closed on Thursdays.

    Any Special Instructions    Maximum 2000 characters
    ENTER SHIPPING ADDRESS
    Country*
    State*
    City*
    Address*
    Pin Code*
    Contact Number*