Request a Locum - Horizon Resourcing

Please complete the following form to Request (Book) a Locum.

Client Details

Name*

Contact Number*

Pharmacy Address*

Billing Address

Pharmacy Details

Pharmacy Type

Pharmacist Role

Dispensing System

Approx Scripts per Day

Drug Addiction Patients per Day

Westers/Dosettes per Day (No.)

Pharmacy Staff (No.)

Dispendary Assistants (No.)

Locum Shift Details

Additional Information

(ie. Locum is Required to Open/Close)

(*) Mandatory field