pay.pharmacierge.com Open in urlscan Pro
51.141.37.245 Public Scan

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Submitted URL:
http://pay.pharmacierge.com/FTc41
Effective URL:
https://pay.pharmacierge.com/FTc41
Submission: On May 08 via manual (May 8th 2024, 11:49:46 am UTC) from CO — Scanned from GB

Form analysis
6 forms found in the DOM

#

<form id="recipientNameEditor" action="#" class="form d-none  mb-4" novalidate="novalidate">
  <div class="row">
    <div class="col-12">
      <p><strong>Recipient</strong></p>
    </div>
    <div class="col-6">
      <div class="form__row" data-plugin="label-animation">
        <div class="form__row-inner mb-0">
          <label for="recipientFirstName" class="form__label">First name</label>
          <div class="form__controls">
            <input type="text" class="form-control animate" name="FirstName" required="" id="recipientFirstName" value="">
          </div>
        </div>
      </div>
    </div>
    <div class="col-6">
      <div class="form__row" data-plugin="label-animation">
        <div class="form__row-inner mb-0">
          <label for="recipientLastName" class="form__label">Last name</label>
          <div class="form__controls">
            <input type="text" class="form-control animate" name="LastName" required="" id="recipientLastName" value="">
          </div>
        </div>
      </div>
    </div>
    <div class="col-12 mt-3">
      <button class="btn mr-2 btn-primary btn-save-recipient">Save</button>
      <a href="#" class="link btn-cancel-recipient">Cancel</a>
    </div>
  </div>
</form>

POST #

<form action="#" method="post" class="address-search form" id="frmAddressSearch">
  <div class="d-flex w-100 justify-content-between">
    <div>
      <div class="form__row  w-100" data-plugin="label-animation">
        <div class="form__row-inner mb-0 d-inline-block">
          <label for="txtPostcode" class="form__label">Postcode</label>
          <div class="form__controls">
            <input id="txtPostcode" value="" type="text" class="form-control animate" aria-label="Postcode">
          </div>
        </div>
        <button id="btnSearchAddress" class="btn btn-primary" type="submit">Search</button>
        <a href="#" class="link btn-manual d-none" id="lnkManualAddress">Enter address manually</a>
      </div>
    </div>
  </div>
  <div class="mt-3"> Collecting in person from our Pharmacy on Wimpole Street? <a href="javascript:void(0);" class="btn-collect-change">Click here</a>
  </div>
</form>

<form>
  <div class="modal-header">
    <h4 class="modal-title">Please choose one of the following options</h4>
    <a href="#" data-dismiss="modal" class="close btn-close-dialog" aria-label="Close">
                        <i class="ico-close"></i>
                    </a>
  </div>
  <div class="modal-body text-center pt-3">
    <div class="row mb-3">
      <div class="col">
        <a href="#" class="btn btn-primary btn-bordered btn-block w-75 mx-auto" data-toggle="modal" data-target="#modalPaymentQuery">I have a query about this prescription</a>
      </div>
    </div>
    <div class="row mb-3">
      <div class="col">
        <a href="#" class="btn btn-primary btn-bordered btn-block w-75 mx-auto" data-toggle="modal" data-target="#modalPaymentUnexpected">I wasn't expecting a prescription</a>
      </div>
    </div>
    <div class="row">
      <div class="col">
        <a href="#" class="btn btn-primary btn-bordered btn-block w-75 mx-auto" data-toggle="modal" data-target="#modalPaymentRefuse">I don't want this prescription</a>
      </div>
    </div>
  </div>
</form>

POST /Order/CustomerQuery/461107

<form id="formCustomerQUery" data-ajax="true" data-ajax-method="POST" data-ajax-success="onCustomerQueryAdded" data-ajax-failure="onCustomerQueryFailed" data-ajax-begin="onCustomerQueryBegin" method="post" enctype="multipart/form-data"
  action="/Order/CustomerQuery/461107" novalidate="novalidate">
  <div class="row">
    <div class="col-12">
      <p>If you have requests for our pharmacy team relating to your medication or delivery preferences, you can give this to us during the online payment process.</p>
      <p>However, if you have a clinical question about your medication prior to payment please enter it here and our pharmacy team will respond to you using the contact details we have on file: </p>
    </div>
  </div>
  <div class="row">
    <div class="col-12">
      <textarea id="txtCustomerQueryMessage" class="form-control" placeholder="Enter question" data-val="true" data-val-required="The Message field is required." name="Message"></textarea>
      <span class="text-danger field-validation-valid" data-valmsg-for="Message" data-valmsg-replace="true"></span>
    </div>
  </div>
  <div class="row mt-4">
    <div class="col-12 text-center">
      <button id="btnSubmitCustomerQuery" type="submit" class="btn btn-primary">Submit question</button>
      <button type="button" data-dismiss="modal" class="btn btn-primary">Close</button>
    </div>
  </div>
  <input name="__RequestVerificationToken" type="hidden" value="CfDJ8GV4bWQp9yxImg-9QMQV5VVFewfzpPvIoHYBOAHxOWP618mtZ_URQsej0Z1FEottP6Y5beznf5fFKQlOcalyC9kA3Y43J9pfHBpUS5WyI1Fs1GLpbEqNJCSsuyl_HRHMetIwNyK1v3Yp9cCdJv4GdwE">
</form>

POST /Order/PaymentUnexpected/461107

<form data-ajax="true" data-ajax-method="POST" data-ajax-success="onPaymentUnexpectedAdded" data-ajax-failure="onPaymentUnexpectedFailed" data-ajax-begin="onPaymentUnexpectedBegin" method="post" enctype="multipart/form-data"
  action="/Order/PaymentUnexpected/461107">
  <button id="btnRequestCallback" type="submit" class="btn btn-primary" data-toggle="modal" data-target="#modalPaymentCallback">Request Callback</button>
  <button type="button" data-dismiss="modal" class="btn btn-primary">Close</button>
  <input name="__RequestVerificationToken" type="hidden" value="CfDJ8GV4bWQp9yxImg-9QMQV5VVFewfzpPvIoHYBOAHxOWP618mtZ_URQsej0Z1FEottP6Y5beznf5fFKQlOcalyC9kA3Y43J9pfHBpUS5WyI1Fs1GLpbEqNJCSsuyl_HRHMetIwNyK1v3Yp9cCdJv4GdwE">
</form>

POST /Order/PaymentRefused/461107

<form data-ajax="true" data-ajax-method="POST" data-ajax-success="onPaymentRefusedAdded" data-ajax-failure="onPaymentRefusedFailed" data-ajax-begin="onPaymentRefusedBegin" method="post" enctype="multipart/form-data"
  action="/Order/PaymentRefused/461107">
  <button type="submit" id="btnSubmitPaymentRefused" class="btn btn-primary">Confirm</button>
  <button type="button" data-dismiss="modal" class="btn btn-primary">Close</button>
  <input name="__RequestVerificationToken" type="hidden" value="CfDJ8GV4bWQp9yxImg-9QMQV5VVFewfzpPvIoHYBOAHxOWP618mtZ_URQsej0Z1FEottP6Y5beznf5fFKQlOcalyC9kA3Y43J9pfHBpUS5WyI1Fs1GLpbEqNJCSsuyl_HRHMetIwNyK1v3Yp9cCdJv4GdwE">
</form>

Text Content

PAY FOR YOUR PRESCRIPTION MEDICATION

YOUR PRESCRIPTION MEDICATION

--------------------------------------------------------------------------------

Thank you for paying for your medication online.
If you have a query about your medication please contact us.

--------------------------------------------------------------------------------

Prescription from Dr MM

Ref: 2458-2033

1DELIVERY ADDRESS

Recipient

K**** A**** Change

Recipient

First name

Last name

Save Cancel
Postcode

Search Enter address manually
Collecting in person from our Pharmacy on Wimpole Street? Click here

2 DELIVERY NOTIFICATIONS

3REQUESTS

4SUMMARY

Delivery Information

Our opening hours can be found here. Payments received after 5pm may not be
processed until the next working day. Payments at weekends may be processed on
Monday morning (excluding public holidays).

Delivery dates will vary dependent on the timing of your prescription, your
payment, your delivery location and the availability of your medication (these
typically range from 0-5 weekdays after payment)

Same day deliveries outside London carry a fee and we also offer international
deliveries. Deliveries to postcodes outside of London will be sent via our
national courier service partners, for next working day delivery.

For postcodes within London, delivery will be via our cycle/motorcycle courier
network. We do not offer ‘leave in safe place’ for any medication, however our
courier will wait at a safe distance while you retrieve your package from the
doorstep.

Why have I received this link?

Pharmacierge has sent you this payment link because we have received a
prescription for you or a family member or colleague. If you're unsure about
this please click here.

Prescription from Dr MM

Ref: 2458-2033

--------------------------------------------------------------------------------

Medication Show details £103.62 Delivery £0.00 TOTAL £103.62

Medication £103.62 Delivery £0.00

To review medication details, please enter Date of Birth for K**** A****

Day12345678910111213141516171819202122232425262728293031
MonthJanFebMarAprMayJunJulAugSepOctNovDec
Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926
We couldn't match that to our records. Submit TOTAL £103.62

Delivery £0.00 TOTAL £103.62

Pay Now

All payments are subject to our Cancellation Policy (opens in a new window)

When you press "Pay Now" you will be referred to our secure payment partner.

Thank you for choosing Pharmacierge.

Delivery Information

Our opening hours can be found here. Payments received after 5pm may not be
processed until the next working day. Payments at weekends may be processed on
Monday morning (excluding public holidays).

Why have I received this link?

Pharmacierge has sent you this payment link because we have received a
prescription for you or a family member or colleague. If you're unsure about
this please click here.

INFO

WARNING!

Yes No

PLEASE CHOOSE ONE OF THE FOLLOWING OPTIONS

I have a query about this prescription
I wasn't expecting a prescription
I don't want this prescription

If you have requests for our pharmacy team relating to your medication or
delivery preferences, you can give this to us during the online payment process.

However, if you have a clinical question about your medication prior to payment
please enter it here and our pharmacy team will respond to you using the contact
details we have on file:

Submit question Close

Alternatively, you can call us on 0207 631 1269 to discuss your prescription.

Your question has been submitted. Our pharmacy team will respond to you using
the contact details we have on file.

This prescription was received by Pharmacierge from Dr MM on 07 May 2024 22:44.
You may request a member of the pharmacy team to call you below.

Request Callback Close

Alternatively you can call us on 0207 631 1269

Thank you. A member of the pharmacy team will call you.

We acknowledge your request not to be contacted again regarding this
prescription. Please click below to confirm your request.

Confirm Close

INTERNATIONAL DELIVERIES

We have experience of difficulties with local customs acceptance of prescription
medicines to your selected country. Please call us on 02076311269 to discuss
your options, or select a different delivery address.

INTERNATIONAL DELIVERY

Based on your selected delivery address we have added a £ delivery charge to
your order.

INTERNATIONAL DELIVERY: Deliveries outside the UK are arranged and undertaken
entirely at the customer’s risk. Whilst Pharmacierge intends to act in good
faith, it accepts no liability in respect of courier non-delivery, delay or
return. Pharmacierge assumes no liability in respect of any import taxes,
customs charges or analogous costs (which the customer is responsible for
paying) and will not be liable (or issue refunds or grant credit) in respect of
defects or delivery interruptions or failures arising as a result of matters
beyond its reasonable control. Such defects and interruptions may be caused by
poor carriage, adverse temperatures and requirements of customs or other border
control authorities. Pharmacierge gives no advice as to the lawfulness of the
delivery of any medication outside the UK and does not advise on whether any
delivery mechanism may be required or appropriate. The customer, by placing an
order for delivery outside the UK, accepts (except to the extent, if any, that
Pharmacierge may not lawfully exclude a relevant liability) these waivers and
exclusions. If specialist delivery has been arranged, it is the responsibility
of the specialist carrier employed, not of Pharmacierge, to ensure that the
requirements are adhered to.

I Agree

--------------------------------------------------------------------------------

London • National • International

Tel 0207 631 1269 | Fax 0800 471 5555 | International +44 207 631 1269 | Get in
touch
43A Wimpole Street, London W1G 8AQ

pay.pharmacierge.com Open in urlscan Pro 51.141.37.245 Public Scan

Form analysis 6 forms found in the DOM

#

POST #

POST /Order/CustomerQuery/461107

POST /Order/PaymentUnexpected/461107

POST /Order/PaymentRefused/461107

Text Content

pay.pharmacierge.com Open in urlscan Pro
51.141.37.245 Public Scan

Form analysis
6 forms found in the DOM