Patient Prescription Request Form

1. Once the prescription request form is completed, your doctor will advise within 5 business days whether a consultation is necessary before prescribing the medication. They will review your recent consultation and the medication requested, as some medications are government-regulated, and will act in accordance with Medicare regulations and guidelines.
2. If a consultation is not required, your doctor will prepare your prescription within approximately 5 business days, depending on their availability. You will receive it as an e-script or hard-copy and a $50 prescription fee will apply.
3. If your child requires a government-regulated medicine and your current doctor is unavailable, please be aware that a full initial consultation with another doctor is required in accordance with Medicare regulations and guidelines. Initial appointment waiting times may be lengthy.

Please tick the box below to agree and proceed with your prescription request.

I have understood and agree with the above information provided