Prescription requests

1 Accept Conditions

2 Personal Details

3 Medication Details

4 Delivery Details

5 Payment

Use this form to request repeat prescriptions for medications that have previously been prescribed by Dr Cunnington, Dr Khoo or Dr Fothergill.
In many cases, your GP will be able to provide prescriptions for you. Your GP receives a letter after each appointment outlining what medications, including dosages, you have been prescribed.
There is a nominal cost of $30 for repeat prescriptions to cover the time taken and administrative costs of writing and issuing prescriptions outside of consultations.

Before you enter details, please read and agree to the Terms and Conditions
This service is only available for existing patients who have been seen in the last 12 months. If you haven’t been seen in the last 12 months, you will need to make an appointment to be reviewed clinically to ensure the medication is still appropriate for you.
We can only provide repeat prescriptions. To obtain a repeat prescription, you must have obtained this prescription from us previously.
You may select more than one medication, up to three, with each request.
Each prescription request is assessed by your doctor who will approve or decline the request on clinical grounds. If the request is declined, you will be advised why and your payment refunded.
The fee ($30) is payable when the request is submitted. If your request is declined, you will receive a full refund within several business days. Payments are managed securely via Stripe.
Scripts will be issued within five (5) working days from submission of the request. Many of the medications prescribed require permits and checking of online databases that track prescriptions and usage so aren’t able to be issued urgently or at short notice.
Delivery via mail may take up to five (5) business days to arrive from the date posted. If you require your prescription earlier, we advise that you select the option to send the prescription directly to your pharmacy via fax or email.
Electronic versions of printed prescriptions sent to patients via email are not legal prescriptions, hence we cannot email prescriptions directly to you.

These details are needed to match you to your clinical records. We will use your email address to communicate with you about your request.
First Name*
Last Name*
Email*
Date of Birth*

DD
MM
YYYY

(1) Name of Medication
(1) Tablet / Capsule Strength
- Add a second Medication...
(2) Name of Medication
(2) Tablet / Capsule Strength
- Add a third Medication
(3) Name of Medication
(3) Tablet / Capsule Strength

Nominate where to send prescription
- Mail (allow at least 5 working days for postage)
- Pharmacy (via fax or email)
Pharmacy Name
Fax Number OR Email Address
Hard copy of prescription needs to be posted to pharmacy.
Address*
Street Address Address Line 2 Town / Suburb State Postcode
Note - Electronic prescriptions will be available from May 2021

Script
Price: $ 30.00
Transactions are securely handled by Stripe. You will receive an email with a receipt on payment.
Credit Card

Card Details

Cardholder Name

Prescription requests

Before you enter details, please read and agree to the Terms and Conditions