Your Pharmacy Name (required) ?
Your Name (required) ?
Your Surname ?
Your Province ? GautengMpumalangaFree StateWestern CapeNorthern CapeNorth WestLimpopoKwazulu NatalEastern Cape
Your Landline Number ?
Your Cellphone Number (required) ?
Your Email (required) ?
Are you the owner ? NoYes
Are you a Pharmacist ? NoYes
Will you be the daily operator ? NoYes
Do you have unencumbered funds available to revamp NoYes
Do you have a CJ Account ? NoYes
CJ account number (required) ?
Pharmacy Turnover ?
Total Shop size (m2) ? Less than 150m2150m2 - 200m2200m2 - 300m2300m2 - plus
Do you have the option of increasing shop sizes ? YesNo
Dispensing Software ?
Ordering System ?
Are you the Responsible Pharmacist ? NoYes
Do you have unencumbered funds available ? NoYes
Tell us in what range your funds are in
By law The Local Choice Pharmacy cannot accept applications that does not meet the minimum requirements. Minimum requirements: A registered pharmacist should be present in the pharmacy A daily operator should be present in the pharmacy and be a shareholder in the pharmacy Unencumbered funds should be available.
Do you have vacant site available ? NoYes
Did you apply for a pharmacy license yet ? YesNo
The Local Choice will submit it on your behalf as part of our full turn-key solution approach to pharmacies.
Did you sign a lease agreement YesNo