Indiana Pharmacy | Indiana Hospital Pharmacy

Indiana Hospital & Heart Institute

Mangalore

How It Works

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1. Verify Phone

Secure OTP verification for your phone number

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2. Fill Details

Provide your personal and delivery information

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3. Upload Prescription

Share your prescription and medicine details

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4. Confirmation

Review and submit your request

Medicine Request Form

Step 1: Phone Verification

Mobile Number

OTP

Step 2: Personal Details

Full Name

UHID (if applicable)

Email Address

Street Address

Apartment/Building

Pincode

Area/Locality

State

City

Landmark (Optional)

Step 3: Prescription & Medicines

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Drag and drop your prescription here or click to browse

Supported formats: JPG, PNG, PDF (Max 5MB)

Additional Medicine Requests

Special Instructions (if any)

Step 4: Review & Submit

Please review your information before submitting:

✓ Verify all personal details are correct
✓ Ensure prescription is clear and readable
✓ Check medicine names and quantities
✓ Confirm delivery address is complete

I confirm that all the information provided is accurate and the prescription is valid

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Home Delivery

Get your medicines delivered to your doorstep

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Quick Processing

Orders processed within 2-4 hours

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Secure & Private

Your data is encrypted and protected