Repeat Prescription – Belgrave Clinic

The repeat prescription ordering service applies to long-term repeat medications only. All requests will be reviewed by a GP and you may be asked to make an appointment in relation to your request.

We ask for an itemised request which helps reduce the risk of medication errors.
We will accept a written/itemised request using a prescription request form available from reception or you can use the adjacent electronic request form.

Please allow 48 hours for your request to be processed, you will receive a text when your prescription has been sent to your nominated pharmacy.

Repeat Prescription Form

"*" indicates required fields

Your full name*

Your phone number*

Your address*

Please select a category*

Private patient

Full medical card

GP visit card (including over 70s medical card and under 8 medical card)

Free contraceptive scheme

Please add your medical card number*

How will you collect your prescription?*

Please add the name and address of your preferred pharmacy*

1. Drug name

Duration of Drug 1

Dose of Drug 1

Strength of Drug 1

2. Drug name

Duration of Drug 2

Dose of Drug 2

Strength of Drug 2

3. Drug name

Duration of Drug 3

Dose of Drug 3

Strength of Drug 3

4. Drug name

Duration of Drug 4

Dose of Drug 4

Strength of Drug 4

5. Drug name

Duration of Drug 5

Dose of Drug 5

Strength of Drug 5

6. Drug name

Duration of Drug 6

Dose of Drug 6

Strength of Drug 6

7. Drug name

Duration of Drug 7

Dose of Drug 7

Strength of Drug 7

8. Drug name

Duration of Drug 8

Dose of Drug 8

Strength of Drug 8

9. Drug name

Duration of Drug 9

Dose of Drug 9

Strength of Drug 9

10. Drug name

Duration of Drug 10

Dose of Drug 10

Strength of Drug 10

Notes about your prescription

This is only for remarks about your prescription. For any clinical concerns or queries, please contact us by telephone.

Repeat Prescription fee

Price:

PRESS SUBMIT TO PROCEED TO PAYMENT