Please use the form to request any prescription items you have had prescribed privately and need repeat prescriptions of. Once this is submitted it will be sent to the duty prescriber and handled within 7 days. If your requirement is extremely urgent please call us on 01414046545.

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Name *

First

Last

Email *

Postcode: *

1. How have you been getting on with your therapy? *

2. What doses are you currently taking? (Please list all meds you need repeated) *

3. Have you experienced any new side effects as a result of therapy? *

Do you require a new prescription ? *YesNo

What length of repeat prescription would you like? £30/3months £55/6months (Can only have 6 months if you have been on LDN for over 6 months) *3 Months6 Months

Enter the items you need a repeat prescription for here *

Has there been any significant change to your conditions that you should tell us about?

Submit