Repeat Prescriptions

Complete the form below, adding up to 4 different medication items.

Name

First Last

Enter Email Confirm Email

Your Date of Birth

Prescription Type

Prescription 1

Medication Name

Dosage (how much do you use?)

Quantity

Supporting Info

Anything else to mention?

Add a Second Prescription

Select/deselect to add a second prescription.

Prescription 2

Medication Name

Dosage (how much do you use?)

Quantity

Supporting Info

Anything else to mention?

Add a Third Prescription

Select/deselect to add a third prescription.

Prescription 3

Medication Name

Dosage (how much do you use?)

Quantity

Supporting Info

Anything else to mention?

Add a Fourth Prescription

Select/deselect to add a fourth prescription.

Prescription 4

Medication Name

Dosage (how much do you use?)

Quantity

Supporting Info

Anything else to mention?

Payment

Select Option

Phone

This field is for validation purposes and should be left unchanged.

Information & Disclaimer

Repeat prescribing does require an annual review with Menopause Decisions to continue to offer you this service. Patients who use testosterone replacement treatment will also require annual testosterone testing after the initial 3 month blood test post initiation or dose changes.

Fees

£35 per prescription to cover the cost of the clinician checking records are correct and issuing the prescription. Alternatively we can offer a one off annual fee of £95. The fee is non refundable but we will allow a 14 day cooling off period.

Pharmacy

Our pharmacy CloudRx will contact you directly to take payment for any prescriptions.

Privacy

Protecting your data is important to us. We follow our privacy policy to ensure this is upheld. By using this form you consent to our privacy policy.