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Refund Request Form

Fill in the form below (* Required) and our accounting team will process your request within 14 business days. Once we have processed the refund, we will send you an email confirmation.
  • PATIENT DETAILS

  • For verification purposes
  • For verification and notification purposes
  • For verification purposes
  • For verification purposes
  • Please note card surcharge is not refundable.
  • CREDIT / DEBIT CARD DETAILS

    Please provide your CREDIT or DEBIT details. The cardholder MUST be under the patient or the patient's parent (if patient is under 14 years old)
  • VISA, MASTER or EFTPOS