575 Mt Eden Road
Phone: 623 4599

Repeat Prescriptions

Enrolled patients may request repeat prescriptions for regular medications.  We will contact you if an appointment with your doctor is needed.  We may not provide repeats if you were not seen for your last script, you are on multiple medications, your medication was changed at your last visit, we have not prescribed this medication for you before or you have an amount outstanding on your account.  

Your prescription request will be actioned within 48 hours. (There may be a delay over weekends and public holidays).  Please allow sufficient time for mail delivery as there may be considerable delays and ensure you have 2 weeks of your medication left to ensure you receive your script on time.  We do not mail controlled drug scripts.  Urgent same day scripts will incurr an additional $10.00 fee.

Please arrange payment at the time of ordering.  Our bank account number is 12-3016-0476955-00.  Please ensure your full name is included.

This form is not available on mobile - to use this form please view on a desktop computer or tablet.

 

Enter your contact information:
Please complete all fields.

   
Full Name:  
Date of Birth:  

Contact Phone Number:

 

 

 

Email:  
Usual Doctor:   
Medication Required:
Please included dosage

 

 

 

I am currently well
I have the following concerns:
(You may be requested to see your doctor.)

  

Have you seen another doctor or changed medications since your last prescription with us?:

 

Yes
No

(Please detail changes below)  

 

 

Choose how to collect your script:
(You must select one)

 

Collect from the practice ($15.00)

Mail to my home address ($25.00)

Fax to a pharmacy ($25.00)

    (Please fill in all fields below)
Pharmacy Name:

 

 
Pharmacy Fax:  
Mailing Address:  
 
   

 

 

 

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