For Members Use Only

Please note: prescription requests can take up to 48 hours to be processed

For patients on our Specialist Hormone Service

Before completing this form, to avoid delay, please check when your review is due. Your review date will be listed on your last prescription which will have been emailed to you when issued. Where appropriate, your clinician may have authorised a repeat, repeat authorisation is highlighted in the prescription. If this is the case, you can contact the pharmacy directly if you are running out before your next review.