Repeat Prescription Request Form

IMPORTANT INFORMATION:

Prescriptions will generally be available to collect two business days after ordering. All urgent requests need to be phoned through to the surgery and will incur a $2 additional fee.

Some pharmacies may have a small fee to receive faxed prescriptions.

Only your regular medications will be issued, no new items or antibiotics.
Repeats can only be issued if you have had a checkup with your GP in the last 12 months (some patients more often).

This is a request only and subject to approval by the GP. We will text or email you if we are unable to fulfill this request.

If you provide a mobile number or email address we will retain this to send reminders and/or accounts.  It will be used only by Masonic Medical Centre.

Fees:  $16 for pickup or Levin pharmacies, $17 for non-Levin pharmacies.  Payments can be made to 01-0666-0240334-10.  Please include your full name or file no. if known.

We appreciate payment of prescription fee online at the time of ordering where possible.

All fields marked with an "*" are required
Patient’s First Name *
Patient’s Surname *
Date of Birth *
Contact Mobile/Email *
Collection instruction *
List name of medications required (regular meds only, each item must be listed separately) *
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