Repeat Prescriptions

• Please call if your request is urgent
• Or book an appointment if your last consult was over 12 months ago
• Otherwise please use the order form below
• Allow 2 working days for your script to be ready
• There is no need to confirm – we will contact you if needed
• $25 / CSC $10 / 0-13 yrs Free + $5 if Fax/Post
• Please pay online to 03 0802 0175929 00 & include your name and date of birth

If you are human, leave this field blank.

First Name *

Surname *

Date of Birth *

(dd/mm/yyyy)

Phone Number *

Daytime contact number

Email *

Doctor *

Dr Mark Rogers

Dr Kim Lawson

Dr Victoria Flight

Dr Frances Matthews

Medications Required *

Please be as detailed as possible

Pick Up or Fax *

Pick up items at Cranford Pharmacy (On-Site at ProMed)

Pick up script at ProMed Reception

Or fax to pharmacy below ($5):

Pharmacy Name & Address

Submit