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Postage must be pre-paid before order is shipped. Contact Geelong Ostomy for latest schedule of postal charges.

Please advise details of any New Medicare Card issue and it's expiry date.

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Yes Med Cert
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Yes Med Cert
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Yes Med Cert
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Yes Med Cert
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Yes Med Cert
(if have one)

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Amount

Yes Med Cert
(if have one)

Brand

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Amount

Yes Med Cert
(if have one)

Brand

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Yes Med Cert
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Brand

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Amount

Yes Med Cert
(if have one)

Brand

Product Code

Amount

Yes Med Cert
(if have one)

This order form should be submitted before 2:30pm on the 18th of the month prior to the required month of distribution (eg 18 Jan for Feb order) to ensure availability on the 5th of month ordered. Be aware of holidays and place your orders early.
Late orders should allow 10 working days for delivery.
Late order changes may incur additional fees, members will be informed prior to order being processed.
Orders will be available for pick-up at 6 Lewalan Street, Grovedale, any Monday, Wednesday or Friday’s after the 5th of the month of distribution between the hours of 9:30am to 2:30pm only.

Member's Detail

This order was placed by:

Distribution Directions:

Postage must be pre-paid before order is shipped. Contact Geelong Ostomy for latest schedule of postal charges.

Please advise details of any New Medicare Card issue and it's expiry date.

Special Instructions or Messages

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Next, press the Submit button only once, please wait for the confirmation of order message - this may take a few minutes