Repeat Prescriptions

If you are already a patient with us and require a repeat prescription, please fill out this form. Our staff will then assess and complete your request. The cost for a repeat prescription is $10.00 unless the Dr advises you require a consult. Consult fees will then apply.

Please note that sometimes we may need you to come into the clinic to see a Doctor before the prescription can be arranged. We will contact you if this is the case.

Patient Name

First Name

Last Name

Email Address

Phone Number

Patient Date of Birth

Message

Please list the medications you require

Destination

Please advise whether you will collect your prescription from us, or if you want it sent to a Pharmacy (the name of pharmacy and their fax number is required)