Prescription Request

This form allows you to order an online repeat prescription. Repeat prescription orders are also possible (and easier) from your patient portal. Please allow up to 48 hours for a repeat prescription request to be processed and payment is due at the time you place your order.

Sometimes it is in your best interests for the doctor to be able to re-assess your condition in case medication changes are required. If an appointment with the doctor or nurse is necessary you will be informed.

Payment is required immediately and can be made by internet banking to 02-1268-0144595-000 or in your MyIndici portal. An invoice will NOT be sent.

We will email or text you when the prescription is on its way to the pharmacy.

If you require a same day urgent prescription ($37) please call the surgery on 03 3588266.

Your Full Name *

Your date of birth *

Your email *

Your phone number *

Your Usual Doctor

Dr Peter Sim

Dr Sharon Ashmore

Dr Mark Longman

Where will you pick up your prescription from? *

Kendal Pharmacy ($27)

Sent to your Pharmacy below ($27)

Name of your pharmacy

Please provide exact full name

Your Required Medication Details *

Please state the name, the dose and how often you take it. eg. Paracetamol 500mg. 2 tablets four times a day. Please put each drug on a new line.

Please do NOT write non specific instructions such as "usual medicines".

HINT : You can copy this information from the pharmacy label on your medication.

Southern Cross Insurance

If you have Southern Cross health insurance which covers GP prescriptions we can charge the cost of your prescription directly to them at your request.

No thank you, I will pay for my prescription myself within the next 7 days.

Yes please charge my Southern Cross Insurance

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