Pharmacy Change Of Ownership Form

As we are onboarding your pharmacy soon, the following information is required to allow for a smooth set up.

Please complete all fields so that we can get Toniq set up and ready to go on your first day!

    Pharmacy Trading Name *

    Business phone *

    Email *

    GST Number *

    Bank Account Number *

    Have you actioned the following?

    Connected Health Information Services Request Form *

    Production Credentials Request Form *
     

    Southern Cross Easy Claim *
     

    Contacted your DHB Portfolio Manager and Te Whatu Ora for your contract *

    Direct Debit Form

    And if you haven’t already signed up for Direct Debit to take advantage of the $5 monthly discount, you can do so here