NEW PRESCRIPTION NEW PRESCRIPTION FORM Name Gender Male Female D.O.B Nationality Contact Number Email Which Alfath branch is near you? Zinj Budaiya Janabiya East Riffa Western Riffa Mashtan st. Almalkiya Jid 'Ali ( I don't know ) Prescription (NB: Uploaded prescriptions include Antibiotics mustn't exceed A week from the date of prescription ) CPR copy What is your medical insurance company? ( if any ) Health 360 Mednet Globmed Next care GEMS ( I don't have ) Insurance Claim, Medical Card Copies Insurance OTP (if any) Are you registered in WE CARE loyalty program? Yes No ( I don't know ) Type of payment ? Cash On Delivery Benefit Pay Message Send As we care of your health that is our main priority, and our duty is to facilitate everything for you. ALFATH PHARMACIES